Request to become AMROTEC dealer Please enable JavaScript in your browser to complete this form.Name *FirstLastCompany Name *Company Industry / Business activities *Company Address *[Please provide your complete business address with Street, Suite/Apt, City, State and Zip Code]Telephone *Email *Website Address *Company's Federal ID (EIN) Number[You can locate your EIN number on your company annual tax filing or obtain 147C letter from IRS by calling 1800-829-0115Please make your selection *I am an existing AMROTEC dealer and have inquiryI am interested in becoming AMROTEC dealer (No E-commerce business). What is your covered States / territory in the United States? What Brand products you are currently offering? *Select Your Model / Type *New MIB-Series Currency Discriminators? (MIB-1, MIB-9, MIB-11V or other MIB-series?)New MIB-Series Banknote Sorters? (MIB-3000 and MIB-5000?Laurel K-Series Banknotes Sorters (K3 / K4 / K8 / K12?)Other (Please specify in comment / message)Qty you would like to purchase each time Selected Value: 1 [Move the slider to give us approx order volume each time]Any comment / Message?Please provide us any comments that may assist us to evaluate your application for a dealership in your state / territoryI accept AMROTEC® Website - Terms and Conditions *I acceptVisit our Terms and Conditions at this link: https://amrotec.com/terms-and-conditions/MessageSubmit
