Channel Dynamics

To become a Channel Dynamics Reseller, please complete the form below.

Your Details

First name*	Last name*
Job title *	E-mail address *
Phone number *

Your Company information:

Company name *

Phone number * (Landline only)

Fax number

What is your company's legal status? *

Company Registration Number

VAT number

Website URL

Date Company commenced trading*

Your Companies Business Activity:

How would you describe your Company?

Market Sectors you sell into

Number of employees *

Billing address:

Company name *

Address Line 1 *

Address Line 2 *

City *

County *

Post code *

Delivery address (if different from above):

Company name

Address Line 1

Address Line 2

City *

County *

Post code *

A) Buyer / Key contact person:

First name*	Last name*
Job title *	E-mail address *
Phone number *	Fax number

B) Sales Manager:

First name*	Last name*
Job title *	E-mail address *
Phone number *	Fax number

C) A/C's Payable contact:

First name*	Last name*
Job title *	E-mail address *
Phone number *	Fax number

Additional Information:

Monthly estimated buying *

Requested payment conditions *

Requested credit limit *

Do you also intend to export products purchased from Channel Dynamics? *

If yes, to which countries?

Do you have a full or partial ownership of any other business?*

If yes, please provide details:

Do you intend to resell Channel Dynamics products to government agencies?*

If yes, please provide details of the government agencies:

Acceptance of Terms: (Managing/Finance Director or Partner)

First name*	Last name*
Job title *	E-mail address *
Phone number *	Fax number

Terms & Conditions:

I declare to have read and accepted Channel Dynamics's Terms & Conditions of Sale.*

The personal and company data you provide to Channel Dynamics will be used with the sole intention of doing business and business related activities. For automation purposes this information might be stored on servers located outside UK. You can at any time object to this and request correction, modification or deletion of your data.
I declare to have read and agree to this and I agree that my email addresses will be used by Channel Dynamics for commercial reasons.

After pressing the "Submit" button below, you will receive an automated e-mail. We wll then contact you in the near future.