New Agent Registration Form

Main Contact Information

Primary Contact First Name *

Primary Contact Last Name *

Primary Contact Title

Primary Contact Email *

Primary Contact Phone Number

Company Information

Company Name *

Main Phone Number *

Fax Number

Website URL *

General Company Email *

Street Address *

Street Address 2

City *

State/Province *

Postal Code

Country *

Company Description *

Industries Served *

You can select multiple (hold "ctrl" and click your selections)

Type of Equipment Sold *

You can select multiple (hold "ctrl" and click your selections)

Territory Served

Do you provide after sales service? *

Manufacturers Represented

IMPORTANT! Only list manufacturers with whom you have an ongoing or exclusive relationship in your territory.

Lines of Business

You can select multiple (hold "ctrl" and click your selections)

Facebook

X (Twitter)

YouTube

Instagram

Privacy Policy Agreement *By checking this box, I provide my consent for PMMI to collect and store my information in the Agents database for use by PMMI members. Further, I consent for PMMI members to use that information to contact me with inquiries and requests for information. I have reviewed PMMI’s privacy policy and understand that I can address privacy concerns or revoke my consent at any time by contacting [email protected].

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Sales Agent Directory

Welcome! Please add your company to PMMI's agent directory.

Main Contact Information

Company Information