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P.O.C. Form
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Company Details
Please provide us with as much information as possible to speed up the account opening process. * Denotes required field.
Name (*)
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Position in Company (*)
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Company Name (*)
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Address 1 (*)
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Address 2
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Address 3
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Address 4
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Town (*)
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County (*)
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Postcode (*)
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Telephone (*)
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Fax (*)
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Email Address (*)
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Website
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Nature of Business (*)
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How did you hear about us? (*)
Internet Search - Google
Internet Search - Yahoo
Internet Search - Bing
Cold Call
Advertisement
Vendor - SonicWALL
Vendor - DBAM
Vendor - VASCO
Vendor - BeCrypt
Vendor - Other
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Type of Account Required (*)
Credit / Debit Card Account (No credit limit)
Standard 30 day credit account
30 day credit account with direct debit
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Desired Credit Limit
£0 - Credit Card Account
£0 - £5k
£5k - £10k
£10+
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VAT Number
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Companies House Registration Number
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Accounts Contact (*)
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Accounts Email (*)
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Accounts Phone (*)
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Trade Reference 1 (for credit accounts only)
Contact Name
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Address 1
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Address 2
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Town
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Postcode
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Phone
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Fax
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Trade Reference 2 (for credit accounts only)
Contact Name
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Address 1
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Town
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Postcode
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Phone
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Fax
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Additional Business Information
Turnover
£0 - £50k
£50k - £100k
£100k - £250k
£250k - £500k
£500k - £1M
£1M - £3M
£5M - £10M
£10M+
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Business Type
Consultancy
Data Network Reseller
Distributor
End User
Internet Retailer
ISP
IT Security Reseller
Managed Service Provider
Manufacturer
OEM
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Employees
1-5
5-10
10-20
20-50
50-100
100+
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Business Focus
Defence
E-Commerce
Education
Government
Health
Insurance
Leisure
Logistics
Manufacturing
Media
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Secondary Business Focus
Defence
E-Commerce
Education
Government
Health
Insurance
Leisure
Logistics
Manufacturing
Media
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What products do you sell?
Computer Peripherals
Consultancy Services
Firewalls
Installation
Internet Solutions
Networking Products
Other
Professional Servics
Software
Structured Cabling
Voice Equipment
VPN
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Can we send you promotional offers and emails? (*)
Yes
No
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What products are you interested in? (*)
Firewalls
VPN Gateway
Peripherals
ADSL Hardware
CDP/Backup
Network Monitoring
Routers/Switches
Computer Components
Data Leakage Prevention
Anti-Virus/Antiphishing
Traffic Shaping/Bandwidth Management
IP Cameras
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Do you have an immediate requirement? (*)
Yes
No
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Online Access
For access to our e-commerce site, please specify a password to use. Once your account is created you will then be emailed your login details to access our site.
Web Store login password
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Terms and Conditions
In order to set up an account with Tekdata Distribution you must read and agree to our terms and conditions of business. Click Here to read the terms and conditions.
I agree to Tekdata's terms and conditions (*)
Agree
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