Please fax the following information for review to become an EILUX product reseller.
By Submitting This Form You Agree To Abide By The MAP Policy Set Forth By EILUX International.
MAP POLICY
Last Name: ___________________________________
Title: ___________________________________
Company Name: _________________________
Tax ID Number: _________________________
Address: ________________________________________
________________________________________
________________________________________
________________________________________
Telephone: ____________________
Fax: ____________________
Website Address: ___________________________________
Email: ________________________________________
Briefly Describe Your Company: ______________________________________________
Comments / Questions: ______________________________________________________
Fax To: 330-722-7152