Distributor Request Form

Please fill out all fields below in English.

[First Name]

[Last(Family) Name]

[Company / Organization]

[Mailing Address]

[City, State / Prefecture]

[Postcode / Zip]

[Country]

[Business Phone]

[Email Address]

Email Address	(Note:You cannot use E-mail with ".@" (dot before @) or ".."(two dots))
Email Address(Confirmation)	(Please enter again to confirm)

[Your URL]

[Which product series are you interested in distributing?]

Cutting Plotters Scanners Label Printers Instrument products

[Which country or region are you interested in representing Graphtec?]

[Purpose]