Membership Application

Fill out the form below to apply for membership in the ICDA. To enable the free exchange of information and mutal cooperation, it is essential that members be noncompetitive in geographical territories.

All fields are required; all responses will remain confidential

Company Name

Principal Phone/Mobile

Principal Email

Principal Name

Website

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Number of Current Branches and Locations (including parent)

Number of Years in Business

Number of Employees (including owners)

Current Authorized Territories

Plans to Open in Other Territories?

Yes

If yes, where

If other, please explain.

Annual Revenue

Financial Year End Date

Additional Dealer Principals

Yes

Additional Principals

Name	Percentage of Ownership

Will more than one Dealer Principal attend the meetings

Yes

Products/Authorized Vendor Relationships

Why are you interested in joining the ICDA?

What out comes do you expect from your membership in this group?

Are you currently utilizing any industry consultants?

What type of operating systems and software do you utilize?

Are you presently a member of any Office Products Organizations, ALLIANCEs or Associations?

Please include a brief profile, brochure or information on your dealership.

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