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Please complete the following form to apply for the D-Link Canadian VIP Channel Partner Program.

 

Primary Contact Information
 
Prefix* : First Name* : Last Name* :
Phone* : - Ext: Mobile : -
Email* : Job Title* :

Company Information
Company* : Address 1* :
Address 2 : City* :
Country* : Province* :
Postal Code* : Website (eg www.sitename.com)*:
Phone* : - Fax : -
Company Ownership* : Reseller Tax ID* :
Number of Inside Sales Reps* : Number of Outside/Field Sales Reps* :
Number of Technical Personnel*: Total Number of Employees* :
Which of the following best describes your channel partner type* :

Fields marked with * are mandatory