Authorized Agents Contact Form
Please complete this form and a representative from the Agent's Partnership group will contact you.
Thank you.
 - required
First Name:  
Last Name:  
E-mail Address
(please enter only one address):
 
Company Name:  
Phone Number: 
Address:  
City:  
State: 
Zip or Postal Code: 
Do you currently own a business?
If so, what kind of business?
Do you have sales experience, particularly office product sales? If so, how many years?
Promotional Email
I would like to receive promotional email from Xerox about the following:
(please select to indicate your areas of interest)