Installer Application

Authorised Installer application:

NOTE: THIS FORM HAS 13 SECTIONS, AND WE REQUIRE DETAILED INFORMATION IN EACH OF THEM. WE WOULD ADVISE THAT YOU LOOK OVER THE FORM, COLLECT THE INFORMATION YOU REQUIRE, THEN RETURN HERE TO COMPLETE THE FORM.

Please note that (*) denotes a required field.

Date of Application*
Nominated Distributor*		Distributor Contact*
1. Contact Information
Application Contact*		E-Mail*
Tel/Mobile*		Responsibility*
2. Company Information
Company Name*		Website Address*
Address*		Date Established*
Postcode*		Country:*
Tel*
Fax
3. Annual Turnover
Forecast this year*
Last year*
ISO 9001/2*
4. Company Directors
Company Director 1*		Company Director 2*
Tel/Mobile*		Tel/Mobile*
E-Mail*		E-Mail*
Responsibility		Responsibility
Company Director 3 / Secretary*		Company Director 4
Tel/Mobile*		Tel/Mobile
E-Mail*		E-Mail
Responsibility		Responsibility
5. Key Personnel
Key Person 1*		Key Person 2
Tel/Mobile*		Tel/Mobile
E-Mail*		E-Mail
Responsibility		Responsibility
Key Person 3		Key Person 3
Tel/Mobile		Tel/Mobile
E-Mail		E-Mail
Responsibility		Responsibility
6. Connections with Brand-Rex
Any previous dealings with Brand-Rex*
Reason for wishing to Join Brand-Rex*
Are you currently Involved/Biding for a Brand-Rex Specified Project (Details)*
7. Projected spend with Brand-Rex (Min £50K p.a. – Jan to Dec)
Month 1-3*		£*
Month 4-6*		£*
Month 7-9*		£*
Month 10-12*		£*
		Total £*

8. Employees Experienced in Structured cabling Systems
Design Engineers		Site Engineers
Numbers*		Numbers*
Manufacturer’s Training Attended		Manufacturer’s Training Attended
No. RCDD		No. RCDD
9. Business Activity
Please describe your principal type of business activity*

10. Other Offices/Locations
1		2
3		4
5		6

11. Which cabling systems are currently part of your product portfolio?
System 1*		System 2*
Approved Since		Approved Since
Approx Spend Per Annum £		Approx Spend Per Annum £
Bought through		Bought through
System 3*		System 4*
Approved Since		Approved Since
Approx Spend Per Annum £		Approx Spend Per Annum £
Bought through		Bought through

12. Reference sites (Please fill in as much information as possible)
Reference Company 1*		Reference Company 2*
Location		Location
Number of Points		Number of Points
System Installed		System Installed
Type (Cat6, Cat5, FO, etc)		Type (Cat6, Cat5, FO, etc)
Reference Company 3*		Reference Company 4*
Location		Location
Number of Points		Number of Points
System Installed		System Installed
Type (Cat6, Cat5, FO, etc)		Type (Cat6, Cat5, FO, etc)
13. Do you buy/install other products?
Product	Approx Spend per annum.	This is text to space out the right column a little bit to make it more even - and more.	Supplied by:
1. Racks
2. Security
3. Telecom
4. Test Equipment
5. Wireless
6. Fibre Cables
7. Copper Cable
8. Telephone Systems
9. Door Entry
10. CCTV

	By ticking this box i hereby declare that all this information is correct at the time of submission
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1. Contact Information

2. Company Information

3. Annual Turnover

4. Company Directors

5. Key Personnel

6. Connections with Brand-Rex

7. Projected spend with Brand-Rex (Min £50K p.a. – Jan to Dec)

8. Employees Experienced in Structured cabling Systems

9. Business Activity

10. Other Offices/Locations

11. Which cabling systems are currently part of your product portfolio?

12. Reference sites (Please fill in as much information as possible)

13. Do you buy/install other products?