Distribution Software Information Request

Enter your company information:

Name:    

Title:   

Company: 

Address: 

City:     State:  Zip: 

Country: 

Phone:    Ext: 

Fax:     

E-mail:  

What is your business specialty in distribution?

Appliance Parts  Automotive Parts  Building Supply  Chemical Supply  Computer: Hardware  Computer: Software  Consultant  Electrical Supply  Electronic Supply  Fastener Supply  Industrial Supply  Irrigation Supply  Janitorial Supply  Medical Supply  Office Supply  Other: Distributor  Other: Non-distributor  Paper Supply  Plastic Supply  Plumbing Supply  Pool & Spa Supply  Power Transmission  Restaurant Supply  Safety Equipment 

What software system are you currently using?

Current Software: 

#Users:           

What operating system does this software currently run on?

DOS Windows SCO/UNIX AIX Other UNIX PICK Windows NT Novel Other Network Other

What type of follow-up would you like?

Literature Only
CD-ROM Demo (sound card required)
VHS Video Tape Demo
Call Me

How did you hear about Amplexus?

Consultant  Guide  Magazine  Mailing  Other  Referral: Another Business  Referral: Association  Trade Show  Web: Another Site  Web: Search Engine 

When will you be making a purchasing decision?

Immediately
1-3 Months
4-6 Months
7-12 Months
1 Year+

Please enter any additional comments below:

Please click the Submit button below to send us your request via email or click Reset to clear the form.

We want to hear from you!
If you experience any difficulty when trying to submit this form please do one of the following:

Print out this request and fax it to us at 415-382-7929

Send an e-mail message to sales@amplexus.com (be sure to include all requested information)

Call our sales department directly at 1-800-4ADVANTAGE (800-423-8268) ext. 835.

Thank you for your request!