Electronic Event Timers and Counters Home | DICG website | Dynapar™ | Eagle-Signal™ | Veeder-Root™
The Best Known Name in Electronic Counters
 
'Become A Distributor' Application Form


DICG sells itsĀ Veeder-Root brand products through a network of highly skilled and trained distributors. DICG distributors offer a variety of value-add services from pre-sales consultation and support to systems integration. They have experience and flexibility to deliver a monitoring, sensing and control solutions to meet our customers' specific application needs.

To become a DICG distributor, please fill out & submit the attached form for consideration in our DICG PartnerPACT program. To learn more about PartnerPACT, please see our Partner sign-in area for more details.

We guarantee to respect your privacy and to never release your personal information to a third party. Please read our Privacy Policyfor further information on this policy. We look forward to serving you!

* All starred fields are required.

Company Information

Company Profile
Annual Sales: $/year
Total Employees:
# Sales Associates: Inside Outside
# Principals:
Field Service/In-House Repair Capability: Yes No
Sales Territory Covered
Specify region and Zip/Postal Code ranges:


Top 5 Product Lines and Percentage of Total Sales:
1st % of Total Annual Sales
Growing Declining Flat
2nd % of Total Annual Sales
Growing Declining Flat
3rd % of Total Annual Sales
Growing Declining Flat
4th % of Total Annual Sales
Growing Declining Flat
5th % of Total Annual Sales
Growing Declining Flat

Company Focus:
Please specify your Top 3 target industries or markets Key Applications in that market:
1st % of Total Annual Sales
2nd % of Total Annual Sales
3rd % of Total Annual Sales
Primary Products of Interest: (all that apply) Anticipated Sales of Dynapar products:
Electronic Counters after 1 year.
Mechanical Counters after 2 years.
Electromechanical Counters after 3 years.
Pneumatic Countersd

Why should Veeder-Root select me as a distributor?:
Be sure to include the benefits you offer both as a sales partner to us, and as a supplier to your customer.


Line Card Info:
Yes, I will be sending a copy of our current line card.
I cannot send a copy of our current line card. Please contact me.

Contact Information

* First Name: Title:
* Last Name: * Company:
* Street Address: * Company Website:
* Email:
* Phone Number:
Fax Number:
* City: * How would you classify your business?
State/Province:
* Zip Code: How would you
like to be contacted?
Phone Email Fax
* Country:

Would you like to receive special offers and notification of new product releases via email? Yes No

Home | About Us | Products & Solutions | Services & Support | News & Events | Downloads | Careers | Contact Us | Help | Site Map | Terms | Privacy Policy

Danaher Industrial Controls Website
2006© Veeder-Root. All rights reserved