Partner Registration

Partner Application Form

Thank you for taking the time to apply to become an authorized Toshiba Canada Partner. We welcome and appreciate your partnership.

PLEASE NOTE: All contacts provided in this form will receive a copy of the application confirmation form as well as the approval confirmation by email.

Please complete all the required fields. Asterisks(*) indicate required entries.

Reseller Info

* The application being submitted is for:	If branch, please enter the first 6 digits of your Corporate Partner Number:
Corporate Head Office Branch Location

* Reseller Company Name:	* Legal Company Name:


Alternative Company Name:


* Address 1:	Address 2:


* City:	* Zip/Postal Code:


* Country:	* State/Province:


* WebSite URL:	Toll-Free Number: xxx-xxx-xxxx


* Main Phone Number: xxx-xxx-xxxx	* Fax: xxx-xxx-xxxx

Contact Info

Owner/President Contact
* First Name:	* Last Name:


* Email:	* Phone: xxx-xxx-xxxx Ext:


* Title:

Sales Contact	Same as Executive Contact
*First Name:	*Last Name:


*Email:	*Phone: xxx-xxx-xxxx Ext:


* Title:

Marketing Contact	Same as Executive Contact
*First Name:	*Last Name:


*Email:	*Phone: xxx-xxx-xxxx Ext:


* Title:

Finance Contact	Same as Executive Contact
*First Name:	*Last Name:


*Email:	*Phone: xxx-xxx-xxxx Ext:


* Title:

Administration Contact	Same as Executive Contact
*First Name:	*Last Name:


*Email:	*Phone: xxx-xxx-xxxx Ext:


* Title:

Company Info

* Size of Business (Personnel)

0-10 100-499
11-50 500+
51-99

* Size of Business (Revenue)

<$100K $250K-$499K
$101K-$249K $500K+

* Monthly Notebook Unit Sales

0-50 201-500
51-100 501-1000
101-200 1000+

* Toshiba Notebook Sales Market Share

0-5% 16-20%
6-10% 20%+
11-15%

* Notebook Brands Sold

HP Asus
Dell Sony
Lenovo LG Electronics
Toshiba Fujitsu
Acer Other
Apple

If other, please specify:

* Successful Verticals

Accounting/Consulting Healthcare
Agriculture/Mining/Fishing/Forestry High Technology/Computer/Software
Banking & Financial Insurance
Charity/Non-Profit Legal Services
Chemical/Oil Manufacturing
Education - Higher (bookstores, universities, colleges) Marketing/Advertising Services
Education - Lower (K-12, school boards) Media Communications (radio/television/newspapers)
Engineering/Construction Utilities
Entertainment/Recreation/Leisure/Travel Real Estate
Food/Drink/Tobacco:Producers Retail/Wholesale/Distribution
Government - Federal Telecommunications
Government - Municipal Transportation
Government - Provincial Other

* New Focus Verticals

* ASP	Yes No
* NMSO Authorized	Yes No

Primary Toshiba Distribution Suppliers

* Which Distribution Suppliers do you currently order from? (Please check all that apply)

Hartco
Ingram Micro
Synnex
Tech Data

Terms and Conditions

I hereby confirm that I am authorized by the above organization to submit this Partner Authorization Application to Toshiba Canada on their behalf and that all details of the application are accurate.

Completed By

* First Name:	* Last Name:


* Title:	* Email:


* Phone: xxx-xxx-xxxx	Ext:

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For further assistance, please contact the help desk toll-free at 1-877-447-8012.

Partner Application Form

Owner/President Contact

Sales Contact

Marketing Contact

Finance Contact

Administration Contact