Axis Communications

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:

Title:

Company name:

Address 1:

Address 2:

City:

Province:

Postal code:

Country:

E-mail:

Phone:

Web site:

Main sales contact for Partner Program

Same as Personal information.

First name:

Last name:

Title:

E-mail:

Phone:

Main technical contact for Partner Program

Same as Personal information.

First name:

Last name:

Title:

E-mail:

Phone:

Company Data

No of employees:

No of Locations:

Company description:

Company vertical:

Axis distributors you buy from:

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

Annual revenue:	$

Axis Solution Partner/Premium Partner/Authorized Partner
Interest for Axis products:	Network Video Document (Print Servers, Network Document Servers)

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.