Become a Partner All fields with an asterisk (*) must be filled in.. GENERAL COMPANY INFORMATION 1. Legal Company Name Legal Name 2. Other names by which your company is known as in business (Doing Business As) Other Name 3. Corporate Headquarters Address Suite/PO Box City PLEASE SELECT A COUNTRY Please select a country Afghanistan - AF Åland Islands - AX Albania - AL Algeria - DZ Amer.Virgin Is. - VI American Samoa - AS Andorra - AD Angola - AO Anguilla - AI Antarctica - AQ Antigua and Barbuda - AG Argentina - AR Armenia - AM Aruba - AW Australia - AU Austria - AT Azerbaijan - AZ Bahamas - BS Bahrain - BH Bangladesh - BD Barbados - BB Belarus - BY Belgium - BE Belize - BZ Benin - BJ Bermuda - BM Bhutan - BT Bolivia - BO Bonaire, Sint Eustatius and Saba - BQ Bosnia-Herz. - BA Botswana - BW Bouvet Island - BV Brazil - BR British Indian Ocean Territory - IO Brunei Dar-es-S - BN Bulgaria - BG Burkina-Faso - BF Burundi - BI Cambodia - KH Cameroon - CM Canada - CA Canary Islands - IC Cape Verde - CV Cayman Islands - KY Central African Republic - CF Chad - TD Chile - CL China - CN Christmas Island - CX Cocos (Keeling) Islands - CC Colombia - CO Comoros - KM Congo - CG Congo (Democratic Republic of the) - CD Cook Islands - CK Costa Rica - CR Croatia - HR Curaçao - CW Cyprus - CY Czech Republic - CZ Denmark - DK Djibouti - DJ Dominica - DM Dominican Rep. - DO East Timor - TL Ecuador - EC Egypt - EG El Salvador - SV Equatorial Guinea - GQ Eritrea - ER Estonia - EE Ethiopia - ET Faeroe - FO Falkland Islands (Malvinas) - FK Fiji - FJ Finland - FI France - FR French Guiana - GF French Sout - TF Gabon - GA Gambia - GM Georgia - GE Germany - DE Ghana - GH Gibraltar - GI Greece - GR Greenland - GL Grenada - GD Guadeloupe - GP Guam - GU Guatemala - GT Guernsey - GG Guinea - GN Guinea-Bissau - GW Guyana - GY Haiti - HT Heard Island and McDonald Isla - HM Honduras - HN Hong Kong - HK Hungary - HU Iceland - IS India - IN Indonesia - ID Iraq - IQ Ireland - IE Isle of Man - IM Israel - IL Italy - IT Ivory Coast - CI Jamaica - JM Japan - JP Jersey - JE Jordan - JO Kazakhstan - KZ Kenya - KE Kiribati - KI Kosovo - XK Kuwait - KW Kyrgyzstan - KG Laos - LA Latvia - LV Lebanon - LB Lesotho - LS Liberia - LR Libya - LY Liechtenstein - LI Lithuania - LT Luxembourg - LU Macau - MO Macedonia - MK Madagascar - MG Malawi - MW Malaysia - MY Maldives - MV Mali - ML Malta - MT Marshall Islands - MH Martinique - MQ Mauritania - MR Mauritius - MU Mayotte - YT Mexico - MX Micronesia - FM Moldavia - MD Monaco - MC Mongolia - MN Montenegro - ME Montserrat - MS Morocco - MA Mozambique - MZ Myanmar - MM Namibia - NA Nauru - NR Nepal - NP Netherlands - NL Netherlands Antilles - AN New Caledonia - NC New Zealand - NZ Nicaragua - NI Niger - NE Nigeria - NG Niue Islands - NU Norfolk Island - NF Northern Marianas - MP Norway - NO Oman - OM Pakistan - PK Palau - PW Palestine - PS Panama - PA Pap. New Guinea - PG Paraguay - PY Peru - PE Philippines - PH Pitcairn Isles - PN Poland - PL Polynesia (French) - PF Portugal - PT Puerto Rico - PR Qatar - QA Reunion - RE Romania - RO Russia - RU Rwanda - RW Saint Barthélemy - BL Saint Helena - SH Saint Kitts and Nevis - KN Saint Lucia - LC Saint Martin (French part) - MF Saint Pierre and Miquelon - PM Saint Vincent and the Grenadines - VC Samoa - WS San Marino - SM Sao Tome and Principe - ST Saudi Arabia - SA Senegal - SN Serbia - RS Seychelles - SC Sierra Leone - SL Singapore - SG Sint Maarten (Dutch part) - SX Slovakia - SK Slovenia - SI Solomon Islands - SB Somalia - SO South Africa - ZA South Georgia and the South Sandwich Islands - GS South Korea - KR South Sudan - SS Spain - ES Sri Lanka - LK Sudan - SD Suriname - SR Svalbard and Jan Mayen - SJ Swaziland - SZ Sweden - SE Switzerland - CH Tadzhikistan - TJ Taiwan - TW Tanzania - TZ Thailand - TH Togo - TG Tokelau Islands - TK Tonga - TO Trinidad and Tobago - TT Tunisia - TN Turkey - TR Turkmenistan - TM Turks and Caicos Islands - TC Tuvalu - TV Uganda - UG Ukraine - UA United Arab Emirates - AE United Kingdom - GB United States - US United States Minor Outlying Islands - UM Uruguay - UY Uzbekistan - UZ Vanuatu - VU Vatican City - VA Venezuela - VE Vietnam - VN Virgin Islands (British) - VG Wallis and Futuna - WF Yemen - YE Zambia - ZM Zimbabwe - ZW Country ZIP/Postal Code Web site 4. Company Description (Please provide a brief description of your company and core competencies) Description 5. How many employees work for your company? PLEASE SELECT A RANGE Please select a range 1 2-4 5-9 10-24 25-49 50-99 100-249 250-499 500-999 1000-2499 2500-4999 5000-9999 10000-14999 15000-19999 20000+ Unknown Employees 6. Do you currently purchase through Distribution? * NO Yes No If yes, please indicate your current/preferred distributor(s): 7. Reason for enrolling in the Partner Advantage Program? PLEASE SELECT A REASON Please select a reason Attended a Tradeshow Received an e-mail or Phone Request Request from Datalogic Sales Rep Request from Distribution Sales Rep Reason for enrolling in the Partner Advantage Program? Comments (Please provide additional information such as the name of an event attended or requesting sales rep etc.) COMPANY SALES DATA 8. What was your company's overall sales in the last completed fiscal year? What was your company's overall sales in the last completed fiscal year? MARKET SEGMENTATION 9. Please specify the geographical areas where your company does business (check all that apply)* Africa Asia/Pac Europe Latin America Middle East North America 10. What percent of your overall sales is sold to the following market segments? * Healthcare Manufacturing Retail Commercial Services Transportation & Logistics Other Market Segments Please specify CONTACT INFORMATION 11. Application Submitted By (Person to be contacted regarding the program application) * First Name Last Name Email PLEASE SELECT A COUNTRY Please select a country Afghanistan - AF Åland Islands - AX Albania - AL Algeria - DZ Amer.Virgin Is. - VI American Samoa - AS Andorra - AD Angola - AO Anguilla - AI Antarctica - AQ Antigua and Barbuda - AG Argentina - AR Armenia - AM Aruba - AW Australia - AU Austria - AT Azerbaijan - AZ Bahamas - BS Bahrain - BH Bangladesh - BD Barbados - BB Belarus - BY Belgium - BE Belize - BZ Benin - BJ Bermuda - BM Bhutan - BT Bolivia - BO Bonaire, Sint Eustatius and Saba - BQ Bosnia-Herz. - BA Botswana - BW Bouvet Island - BV Brazil - BR British Indian Ocean Territory - IO Brunei Dar-es-S - BN Bulgaria - BG Burkina-Faso - BF Burundi - BI Cambodia - KH Cameroon - CM Canada - CA Canary Islands - IC Cape Verde - CV Cayman Islands - KY Central African Republic - CF Chad - TD Chile - CL China - CN Christmas Island - CX Cocos (Keeling) Islands - CC Colombia - CO Comoros - KM Congo - CG Congo (Democratic Republic of the) - CD Cook Islands - CK Costa Rica - CR Croatia - HR Curaçao - CW Cyprus - CY Czech Republic - CZ Denmark - DK Djibouti - DJ Dominica - DM Dominican Rep. - DO East Timor - TL Ecuador - EC Egypt - EG El Salvador - SV Equatorial Guinea - GQ Eritrea - ER Estonia - EE Ethiopia - ET Faeroe - FO Falkland Islands (Malvinas) - FK Fiji - FJ Finland - FI France - FR French Guiana - GF French Sout - TF Gabon - GA Gambia - GM Georgia - GE Germany - DE Ghana - GH Gibraltar - GI Greece - GR Greenland - GL Grenada - GD Guadeloupe - GP Guam - GU Guatemala - GT Guernsey - GG Guinea - GN Guinea-Bissau - GW Guyana - GY Haiti - HT Heard Island and McDonald Isla - HM Honduras - HN Hong Kong - HK Hungary - HU Iceland - IS India - IN Indonesia - ID Iraq - IQ Ireland - IE Isle of Man - IM Israel - IL Italy - IT Ivory Coast - CI Jamaica - JM Japan - JP Jersey - JE Jordan - JO Kazakhstan - KZ Kenya - KE Kiribati - KI Kosovo - XK Kuwait - KW Kyrgyzstan - KG Laos - LA Latvia - LV Lebanon - LB Lesotho - LS Liberia - LR Libya - LY Liechtenstein - LI Lithuania - LT Luxembourg - LU Macau - MO Macedonia - MK Madagascar - MG Malawi - MW Malaysia - MY Maldives - MV Mali - ML Malta - MT Marshall Islands - MH Martinique - MQ Mauritania - MR Mauritius - MU Mayotte - YT Mexico - MX Micronesia - FM Moldavia - MD Monaco - MC Mongolia - MN Montenegro - ME Montserrat - MS Morocco - MA Mozambique - MZ Myanmar - MM Namibia - NA Nauru - NR Nepal - NP Netherlands - NL Netherlands Antilles - AN New Caledonia - NC New Zealand - NZ Nicaragua - NI Niger - NE Nigeria - NG Niue Islands - NU Norfolk Island - NF Northern Marianas - MP Norway - NO Oman - OM Pakistan - PK Palau - PW Palestine - PS Panama - PA Pap. New Guinea - PG Paraguay - PY Peru - PE Philippines - PH Pitcairn Isles - PN Poland - PL Polynesia (French) - PF Portugal - PT Puerto Rico - PR Qatar - QA Reunion - RE Romania - RO Russia - RU Rwanda - RW Saint Barthélemy - BL Saint Helena - SH Saint Kitts and Nevis - KN Saint Lucia - LC Saint Martin (French part) - MF Saint Pierre and Miquelon - PM Saint Vincent and the Grenadines - VC Samoa - WS San Marino - SM Sao Tome and Principe - ST Saudi Arabia - SA Senegal - SN Serbia - RS Seychelles - SC Sierra Leone - SL Singapore - SG Sint Maarten (Dutch part) - SX Slovakia - SK Slovenia - SI Solomon Islands - SB Somalia - SO South Africa - ZA South Georgia and the South Sandwich Islands - GS South Korea - KR South Sudan - SS Spain - ES Sri Lanka - LK Sudan - SD Suriname - SR Svalbard and Jan Mayen - SJ Swaziland - SZ Sweden - SE Switzerland - CH Tadzhikistan - TJ Taiwan - TW Tanzania - TZ Thailand - TH Togo - TG Tokelau Islands - TK Tonga - TO Trinidad and Tobago - TT Tunisia - TN Turkey - TR Turkmenistan - TM Turks and Caicos Islands - TC Tuvalu - TV Uganda - UG Ukraine - UA United Arab Emirates - AE United Kingdom - GB United States - US United States Minor Outlying Islands - UM Uruguay - UY Uzbekistan - UZ Vanuatu - VU Vatican City - VA Venezuela - VE Vietnam - VN Virgin Islands (British) - VG Wallis and Futuna - WF Yemen - YE Zambia - ZM Zimbabwe - ZW Country City ZIP/Postal Code Address Position/Department Phone I hereby represent to have read the Privacy Policy and Information Notice*. By clicking this box, specifically I agree to be kept in the marketing list of Datalogic for the purposes as described in the Information Notice By clicking this box, I further agree that my personal data are communicated to Authorized Commercial Partners for marketing and commercial initiative purposes as reported in the Information Notice * Please read carefully the Information Notice and Privacy Policy before click “SEND” CLEAR THE FORM SEND TOP ®: 2000-2021 Datalogic S.p.A. All rights reserved. Specifications subject to change without notice. Legal Notice