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Axis Partner Program Request Form

The Program is open to all resellers doing business with an authorized Axis distributor. Please fill out all fields completely.

Company & personal information

First name:

Last name:

Department:

E-mail:

Company name:

Address:

Phone:

Postal code:

Fax:

City:

Web site:

Country:

Product Manager for Axis Products		Same as Personal information.

First name:

Last name:

Department:

E-mail:

Phone:

Marketing Contact		Same as Personal information.

First name:

Last name:

Department:

E-mail:

Phone:

Sales Contact		Same as Personal information.

First name:

Last name:

Department:

E-mail:

Phone:

Technical Contact		Same as Personal information.

First name:

Last name:

Department:

E-mail:

Phone:

Company Data

Nr of employees:

Franchises:

Active customers:

Company description:

Company vertical:

Axis distributors you buy from:

Distributor name: (please select at least one distributor)	Account no.:

Turnover Axis products:	USD
Company turnover:	USD

Axis Solution Partner/Premium Partner/Authorized Partner

Interest for Axis products:

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By submitting this request form, and joining the Axis Partner Program, you automatically grant Axis permission to add your company contacts info to the Axis database for future communications.
The request form will be reviewed by Axis, and your partner status will be communicated back to you.

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Axis Partner Program Request Form

Company & personal information

Product Manager for Axis Products

Marketing Contact

Sales Contact

Technical Contact

Company Data

Axis Solution Partner/Premium Partner/Authorized Partner