Tech Data

Welcome to TechData.com!

New Customer Registration Form

Please complete this form only if you are a qualified authorized reseller.

If your company is located in the U.S., follow the instructions for domestic customers, or call our Domestic Accounts Departments at 1-800-237-8931, Ext. 78196.

Please make sure to include your email address when filling out the form. You will receive a confirmation message which should be printed, signed and faxed back to our Miami offices at (01) 305-718-3004. We cannot process the application without an authorized signature.

If you have any questions, e-mail us at latam@techdata.com, or call 305-718-3160 (Latin American/Caribbean/International customers).

Company Information

Company name:
Physical address:
City:
State/Province:
ZIP Code:
Country:
Telephone:
Fax:
Your Email: * This field is required

Corporation

Sole Proprietorship

Partnership

Years in business:	Time at current address:
Business operated from: Commercial building Home
Do you rent or own this property?
Amount of annual sales: US$
Estimated monthly purchases from Tech Data: US$
Tax Exemption #:
Dun & Bradstreet #:

Which category best describes your primary business? (Check only one)
Direct Marketer (Catalog or Internet)	Retail
Systems Integrator (incl. OEM)	Distributor
Technical Service and Consultant	Manufacturer
Value Added Reseller (VAR)	Exporter
ISP / ASP or other Internet services

What market segment do you serve? (Check multiple if needed)

Consumer (end-user)

Academic/Education

Government (all branches)

Corporations (all sizes)

Which manufacturer authorizations do you hold?

What are your annual purchases through distribution? (Check one only)

Under US$500,000

Over US$500,000 - US$1,000,000

Over US$1,000,000 - US$5,000,000

Over US$5,000,000 - US$10,000,000

Over US$10,000,000 - US$25,000,000

Over US$25,000,000 - US$100,000,000

Over US$100,000,000 - US$500,000,000

Over US$500,000,000

Contact Information

It is important that you provide detailed information about the individuals we are to contact within your company. First contact should preferably be the president, general manager or owner. Second contact should preferably be the owner. Third contact must be the authorized buyer. Fourth contact must be the person in charge of Accounts Payable.

Contact #1 - (President, General Manager, Owner)

Name:
Title:
Telephone:
E-mail:
Fax:

Would you like to be contacted by phone?	Yes	No
Would you like to receive e-mail?	Yes	No
Would you like to receive faxes?	Yes	No
Would you like to receive regular mail?	Yes	No

Contact #2 - (Owner)

Name:
Title:
Telephone:
E-mail:
Fax:

Would you like to be contacted by phone?	Yes	No
Would you like to receive e-mail?	Yes	No
Would you like to receive faxes?	Yes	No
Would you like to receive regular mail?	Yes	No

Contact #3 - (Authorized Buyer)

Name:
Title:
Telephone:
E-mail:
Fax:

Would you like to be contacted by phone?	Yes	No
Would you like to receive e-mail?	Yes	No
Would you like to receive faxes?	Yes	No
Would you like to receive regular mail?	Yes	No

Contact #4 - (Accounts Payable)

Name:
Title:
Telephone:
E-mail:
Fax:

Would you like to be contacted by phone?	Yes	No
Would you like to receive e-mail?	Yes	No
Would you like to receive faxes?	Yes	No
Would you like to receive regular mail?	Yes	No

Shipping Information

Freight Forwarder #1:
Contact:
Address
City:
State:
ZIP Code:

Freight Forwarder #2:
Contact:
Address:
City:
State:
ZIP Code: