YOUR COMPANY (If multiple locations, list headquarter information and list branch info on location page.) Which markets do you sell into? (check all that apply) Direct-to-Garment Specialty Dye-Sublimation Corporate Dye-Sublimation Photography Signage I m authorized to sell the following Digital Printing Systems (check all that apply) AnaJet Brother Kornit DuPont DNP Canon Hewlett Packard Kornit Kodak Xerox Fuji Seiko Other
YOUR COMPANY (Continued...) What services do you provide to your customers? (check all that apply) Hardware & Software Service & Support Supplies Sales Consulting Services On-site Installation Product Training How do you sell and market your products or services? (check all that apply) Use Customer Database Print Advertising Catalog Internal Telesales Direct Mail Seminars Trade Shows & Events Field Sales Visits Newsletters Showroom & Demos Other What Application Software or RIP Brands do you sell and support? (Check all that apply) EFI Wasatch MultiRIP Adobe DTG Rip ColorBurst Ergosoft iproof Other Number of sales representatives in your company? How many years in business? Inside Field How many locations? How many sales representatives would sell EPSON products? Have you sold EPSON products previously? Inside Field If yes, what products? Total revenue the last 12 months $ ANTICIPATED QUARTERLY SALES FOR EPSON PRODUCTS (in printer units) 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter (Jan/Feb/Mar) (Apr/May/June) (Jul/Aug/Sep) (Oct/Nov/Dec) SCF2000WE SCF2000SE SCF2000DEMO
YOUR ANTICIPATED PROFOCUS LEVELS (your best guess) Epson SureColor F2000 Series Premier Level (15 to 10 units per qtr.) Premier Elite Level (21 or more per qtr.) If applicable, what distributor(s) do you purchase from? (Specify) AUTHORIZATION BY YOUR COMPANY Authorized Signature Print Name Date By signing and submitting this, your company (1) certifies the information is true, and (2) agrees to all the terms and conditions for being an Authorized ProFocus DTG Reseller. Please use the attached form(s) to list the geographic regions/cities you intend to actively sell to, and a list of your branch offices that will support these regions/cities (See attached form). PLEASE RETURN THIS APPLICATION TO EPSON AT: Fax: 562-997-5789 Epson America, Inc. Sales Operations, MS 4-10 3840 Kilroy Airport Way Long Beach, CA 90806 INTERNAL EPSON USE ONLY Application Received Date Reviewed and Approved by Date Sales Rep. Assigned No. Assigned
STORE LOCATIONS (Please copy this page as needed for additional locations.) Number of Sales Reps Names of Sales Representatives ADDITIONAL STORE LOCATIONS Number of Sales Reps Names of Sales Representatives
Demo Unit & Trade Show Order Form Contact Information All Fields Required Ship To Information Use Same Address Info. on Left Company Name Ship To Location (Company Name, Trade Show Name, Booth Number, etc.) Contact Name Contact Name City, State, ZIP City, State, ZIP Contact Phone Number Contact Phone Number Contact Fax Number Contact Cell Phone Number (Required for Trade Shows) Ordering Information Epson Ordering Code Product Description MSRP Demo Price Quantity Extended Price SCF2000DEMO Epson SureColor F2000 White Edition $19,995 $13,997 I m a reseller, so I don t need to pay sales tax. I m sending my tax exempt form in with this order. (if not already on file) SALES TAX (based on shipping address) Shipping Information Shipping & Handling - Business with Loading Dock Access $150 Shipping & Handling - Residential, Tradeshow, or No Loading Dock Access $250 GRAND TOTAL Payment Method Credit Card Check Purchase Order Type of Credit Card: (Visa, MC, Discover, AMEX) Name on Credit Card: Credit Card Number: Expiration Date: Credit Card Signature: Date: PLACE MY ORDER NOW! To order, simply FAX this form to 1-800-333-0669. All orders are subject to approval by Epson. All sales are final, no exchanges or refunds. Product purchased under this program can be resold. Subject to availability, please allow 7 to 10 business days for delivery. Epson America, Inc. has the right to terminate or modify this program at any time. See program documents for more detail. Epson is authorized to bill any and all charges under this program to the credit card identified above. This authorization remains in effect until reseller provides written notice of revocation to Epson, in a matter that affords Epson a reasonable opportunity to act on the notice.