Distributor Application Form (RTU)

Do you want to become an official Distributor of our RTU Products?
Please fill in all data below and we will promtly return with further requirements to become an official representative of our RTU / Data logger products.

- This company profile will be held stricktly confidential and is only for internal use of Micro Technic

Fields marked with * are required

Company name *
Titulation Mr. Mrs. Ms.

First Name *
Last Name *
Title
Dept
Street *
Zip *
City *
Country *        
Phone No *
Fax No
Email address *
HomePage
Company activity: *


Staff (number of employees): *
Number of salesmen: *
Description of the activities:

Our company is : 
- 100% Integrator:  or
- 100% Distributor  or
-   % Integrator and   % Distributor 

Total Annual Turnover : last year :   US$ 
two years ago:   US$ 

In which sector do you think your company is mostly specialised:   


Sector of Activities - Good - - Fair -  - None - 
Industrial Controls
Machine Builders
Medical Equipment
Optical Equipment
Communication Equipment
Transportation
Water Distribution/Treatment
Building Automation
Irrigation
Gas
Heating
Meteorology
Fridges & Cold installations
Other Industries

Others (please specify):
Extra comments ?

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