Partner Application

Are you looking to become a Telect distributor, representative or value-added reseller? Please begin by completing the information below.

Executive Contact Information
First Name:	*
Last Name:	*
Job Title:	*
E-Mail:	*
Phone:	*
Fax:
Company Profile
Company Name:	*
Address:	*

City/State:	* *
Zip/Postal Code:	*
Country:	*
Website URL:	*
Number of Inside Sellers:	*
Number of Outside Sellers:	*
Total Number of Employees:	*
Years in Business:	*
Annual Revenue:	*
Ownership:	Private Public
Target Market(s):	Telecom Data CATV Wireless Government Utilities Others:
Total Number of Vendors:

Principle Vendor Lines *

Additional Vendors You Represent *

Geographic Regions You Service *

Please provide a brief description of your company and its value proposition regarding Telect products *

* Required Field