* = required 1. Company Overview
Business Name *
Trading Name
Previous Name
Address Line 1 *
Address Line 2
Address Line 3
Town *
County *	-- Please Select -- Aberdeenshire Angus Argyll & Bute Argyllshire Avon Ayrshire Ballymena Banffshire Bedfordshire Berkshire Berwickshire Borders Brecknockshire Buckinghamshire Buteshire Caernarfonshire Caerphilly Caithness Cambridgeshire Cardiganshire Carmarthenshire Channel Islands Channel Islands  Cheshire Clackmannanshire Cleveland Clwyd Conway Cornwall County Antrim County Armagh County Derry County Down County Durham County Fermanagh County Londonderry County Tyrone Coutny Antrim Cromartyshire Cumberland Cumbria Denbighshire Derbyshire Devon Dorset Dumfries & Galloway Dumfriesshire Dunbartonshire Dyfed East Ayrshire East Dunbartonshire East Lothian East Renfrewshire East Sussex East Yorkshire Essex Fife Flintshire Gibraltar Gloucestershire Gwynedd Hampshire Herefordshire Hertfordshire Highlands Humberside Huntingdonshire Inverclyde Inverness-shire Isle of Anglesey Isle of Man Isle of Wight Kent Kincardineshire Kirkcudbrightshire Lanarkshire Lancashire Leicestershire Lincolnshire London Merioneth Merseyside Merthyr Tydfil Mid Glamorgan Mid Lothian Middlesex Midlothian Monmouthshire Montgomeryshire Morayshire Nairnshire New York, USA Newport Norfolk North Ayrshire North Lanarkshire North Yorkshire Northamptonshire Northumberland Nottinghamshire Orkney Other Oxfordshire Peeblesshire Pembrokeshire Perthshire Powys Radnorshire Renfrewshire Rhondda Cynon Taff Ross-shire Roxburghshire Rutland Scotland Selkirkshire Shetland Islands Shropshire Somerset South Ayrshire South Glamorgan South Humberside South Lanarkshire South Lankarkshire South Yorkshire South Yorkshire  Staffordshire Stirlingshire Suffolk Surrey Sussex Sutherland Torfaen Tyne & Wear Vale of Glamorgan Warwickshire West Berkshire West Dunbartonshire West Glamorgan West Lothian West Midlands West Sussex West Yorkshire Western Isles Westmorland Wigtownshire Wiltshire Worcestershire Yorkshire
Post Code *
Company Reg No *
Contact Number (landline) *
Fax Number*
Website Address
Turnover (last years figures)*
Number of locations	0 1 2 3 4 5 6 7 8 9 10+
Total number of people employeed *
Total: All employees -- Please Select -- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 25+ Total: Technical -- Please Select -- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 25+
Primary Contact Details *
First Name *
Surname *
Email *
Mobile
Secondary Contact Details
First Name
Surname
Email
Mobile
Main Business Channel (tick as many as relevant)
Consultant Data Specialist IT High Steet Retailer (Computers/Printers/Storage) IT Reseller (Computers/Printers/Storage) Office Equipment Reseller (Furniture/Stationery/Photocopiers) Service Company Voice Specialist Web based Sales Company
Specialisation * Tick all that apply
PC Mac
What services do you offer? * Tick all that apply
Repairs and upgrades Hardware installation Software Installation Network setups (including wireless) Protection & security Voice over IP Home entertainment setup Back up and data recovery
Accreditations (tick as many as relevant)
Apple BT CompTIA Microsoft Sage
Customer Profile Sectors (tick as many as relevant)
Central Government Consumer Education Finance Local Government Manufacturing Retail Service SME’s
fixITlocal line *
2. fixITlocal Subscription
You may register for any of the programmes listed below. To be included in the Call locator and receive telephone calls you must sign up to one or both of the fixITlocal Programmes. A minimum of one programme must be selected.
Programmes
Please tick the programmes that you wish to receive enquiries from.
Consumer Business Sage
3. Service Module
Fixitlocal resellers can register to receive service and installations calls, These are allocated by the Vendors or Automatically by nearest search. To accept calls you must provide an email address where the calls will be sent and a mobile number to receive an SMS call alert. To accept a call you must respond within 4 hours.
Email address for Service Alerts
Mobile Number for SMS alerts
4. Trade Association
To ensure customers get a high level of service and give you a selling advantage, fixITlocal require that all resellers who register for the programme are a member of the Technology Channels Association (TCA) and agree to conform to the Code of Practice.
Please select below if you are a paid member of the Technology Channels Association (TCA).*
Yes No
If Yes please go to Section 5. If No please sign up below:
i) Please sign me up for the TCA membership at the special first year rate of £75. This will be invoiced once you have completed the registration. I agree to be bound by the code of practice and the rules of the association.Click here to view.
GFK Reseller Panel
In addition to the TCA membership you are also able to sign up to be part of the GFK Reseller Panel. Once you are a panel member you will receive a variety of market information reports from GFK which will keep you up to date on the state of the IT market in the UK and on the state of the UK economy in general. GFK are offering TCA members a £25 rebate off membership. Please Click here to view details and sign up.
5. Special Deals
FixITLocal have teamed up with Synaxon to enable you to take advantage of some of the best buying terms on IT Products.
Please tick here if you wish Synaxon to contact you.
Please confirm to accept our Terms and Conditions.
If you have any queries regarding this form, please contact the Reseller Sales Team on 01708 776 005 or email resellers@dmsluk.co.uk