Thank you for your interest in becoming Bar Code India Reseller. Simply fill out the following on-line application and submit it. We’ll get back to you shortly.
  Please enter your Company Contact information.
    * mandatory fields
  First Name* :
  Last Name* :
  Title :
  Company Name* :
  Address* :
  City* :
  State/Province :
  Zip/Postal Code* :
  Country* :
  Direct Telephone* :
  Cell Phone :
  Fax :
  Direct Email* :
  Company URL :
 
Please enter your Company's Business Profile.
President/Owner's Name:
Business Form:
Sole Proprietor 
Partnership 
Corporation 
What year was the company founded?
Describe your primary business:
Last year's revenues:
From which market segment does majority of your revenue come? Name at least three.
Number of employees:
Number of sales personnel:
How many sales offices do you have?
Number of technical personnel:
Number of administrative personnel:
Market territory:
Market applications:
List of main products currently carried:
Product Name
Manufacturer
Since (year)
Remarks:
Which Products are you interested in selling? (check all that apply) *
Scanners
Fixed Mount Scanners
Printers
WLAN Infrastructure
Mobile Computers
RFID Readers & Tags
How did you hear about us?
Web Search Engine 
Surfing the Net
Magazine
Print ad
Brochure
Trade Show
Word of mouth
Other