Register as dealer
  1. Dear Sir / Madam,

    I am interested in including an AMAZONAS article in what I/we offer and also request to be admitted into the AMAZONAS specialist dealer network.

  2. Title
  3. First name*
    Please type your first name here.
  4. Surname*
    Please type your surname name here.
  5. Company*
    Please type your company name here.
    (incl. type)
  6. General Manager
    (if different)
  7. Address*
    Please type your address here.
  8. Post/Zip Code*
    Please type your Post/Zip Code here.
  9. City*
    Please type the name of your city here.
  10. Country*
  11. Telephone*
    Please type your telephone number here.
  12. Fax
  13. E-mail*
    Please enter your valid e-mail address here.
  14. Internet
  15. The fields marked with a * must be completed

  16. Company Details

    In order to get to know your company better, we require the following details from you:
  17. How many employees work at your company?
    (number of people)
  18. You operate in:*
    Please select your company type here.
  19. Storesize of
    Please type your first name here.
    (in m²)
  20. Your branch is:*
    Please select your branch here.
  21. Your branch is:
    (if other)
  22. The details you have provided to us will only be recorded for internal statistics and service purposes. Naturally we will treat your details with the utmost confidentiality and guarantee that we will not pass them onto a third party. If requested we will delete your details.

  23. Your opinion is important to us!
  24. How did you find out about us?
  25. Other comments: wishes, suggestions, advice etc.
  26. Ungültige Eingabe