Dealer Application

To become an authorized SafeTec dealer, please fill out the following form and provide detailed information where applicable. Required information is marked with an asterisk (*).

Company Information

Company *

Address *

City *

State *

Zip Code *

Contact Information

Phone *

Fax

Email *

URL

About Your Company

Tell us about your company *

Which industries are you going to market the platform? *

How many salespersons do you have? *

Is your company able to provide demos and stock inventory? Yes No

Please provide additional information that might aid in your case to become a distributor

* Please make sure you fill in the required fields