- OEM Program Sign Up

1-866-223-2860

div_603

div_604

div_647

- 0 items

Shop By Category

CX4 Cables / InfiniBand Cables

Fiber Optic Cables

Coaxial Cables

HDMI Cables / DVI Cables

Audio Video Monitor Cables

D-Sub Cables & Adapters

GPIB IEEE-488 Cables

Computer & Storage I/O Cables

Cat5e / Cat6 / Telco Cables

USB Cables / Firewire Cables

SFP+ Modules & Cables

Test Cards

Shop By Application

High Speed Networking

Test and Instrumentation

Server and Storage

Computer Peripherals

Home Theater

More ways to Shop

Hot Items

New Items

Overstock

ACD OEM Program Sign Up

Instructions: All information must be complete.

General Company Information:

* Legal Entity (check one):

Corporation

Partnership

Proprietorship

* Name of Business

Contact Information:

* First Name

* Last Name

* Title

* Street Address 1

Street Address 2

* City, State, Zip

* Main Telephone Number

* Fax

* Email address

* Federal Tax ID#

Dun & Bradstreet Number

* D&B Rating

* Rating Date

* Line of Business

* Principals

* Number of Years in Business

Accounts Payable Contact Information:

* Name

* Email

* A/P Phone # including extension if applicable

* Products Manufactured

BANKING:

* Bank of Account:

* Street Address 1:

Street Address 2:

* City, State, Zip:

Bank Account Officer Contact:

* Name:

* Telephone:

PRINCIPAL TRADE SUPPLIERS- PLEASE PROVIDE 3 REFERENCES:

Name:

Street Address 1:

Street Address 2:

City, State, Zip:

Telephone:

Name:

Street Address 1:

Street Address 2:

City, State, Zip:

Telephone:

Name:

Street Address 1:

Street Address 2:

City, State, Zip:

Telephone:

Additional Locations:

Please include any additional sales and/or shipping locations below.

Address 1

Address 2

City, State, Zip

Contact

Phone

Address 1

Address 2

City, State, Zip

Contact

Phone

Contacts:

Please let us know the primary contact for Amphenol Cables on Demand.

* Name of Applicant:

* Company:

* Title:

* Email Address:

* Phone:

form rc