﻿<?xml version="1.0" encoding="UTF-8"?>
<?xml-stylesheet type="text/xsl" href="/atomosxml-html5.xsl"?>
<html xmlns:a="atomos.com">
	<head>
		<title>Dealer, Distributor Interest</title>
	</head>
	<body>
	    <div id="banners" class="bannerlist">
          <a href="/wheretobuy/"><img src="/graphics/headbanner-ninja.png" alt=""/></a><a href="/orders.xml"><img src="/graphics/headbanner-samurai.png" alt=""/></a><a href="/ninja/"><img src="/graphics/headbanner-tools.png" alt=""/></a><a href="/dealers.xml"><img src="/graphics/headbanner-reseller.png" alt="" /></a>
        </div>
		
		<a:heading>Dealer, Distributor Interest</a:heading>
		
		<p>Please submit this form to express interest in distribution of Atomos products.</p>

		<form method="post" action="http://www.atomos.com/lists/?p=subscribe&amp;id=2" name="subscribeform">
		<table>
		<tr><td><div class="required">Email</div></td></tr>
		<tr><td class="attributeinput"><input type="text" name="email" value="" size="40"></input>
		<script language="Javascript" type="text/javascript">addFieldToCheck("email","Email");</script><input type="hidden" name="htmlemail" value="1"></input></td></tr>

		<tr><td><div class="required">Your Name</div></td></tr>
		<tr><td class="attributeinput"><input type="text" name="attribute8"  class="attributeinput" size="40" value=""></input>
		<script language="Javascript" type="text/javascript">addFieldToCheck("attribute8","Your Name");</script></td></tr>

		<tr><td><div class="required">Your Company</div></td></tr>
		<tr><td class="attributeinput"><input type="text" name="attribute9"  class="attributeinput" size="40" value=""></input><script language="Javascript" type="text/javascript">addFieldToCheck("attribute9","Your Company");</script></td></tr>

		<tr><td><div class="required">Product</div></td></tr>
		<tr><td class="attributeinput"><!--0-->
		<select name="attribute1" class="attributeinput">
			<option value="1">All</option>
			<option value="4">Connect</option>
			<option value="2">Ninja</option>
			<option value="5">Ninja 2</option>
			<option value="3">Samurai</option>
		</select></td></tr>

		<tr><td><div class="required">Street Address</div></td></tr>
		<tr><td class="attributeinput">
        <input type="text" name="attribute4"  class="attributeinput" size="40" value="" /><script language="Javascript" type="text/javascript">addFieldToCheck("attribute4","Street Address");</script></td></tr>

		<tr><td><div class="required">City</div></td></tr>
		<tr><td class="attributeinput"><input type="text" name="attribute5"  class="attributeinput" size="40" value="" /><script language="Javascript" type="text/javascript">addFieldToCheck("attribute5","City");</script></td></tr>

		<tr><td><div class="required">State</div></td></tr>
		<tr><td class="attributeinput"><input type="text" name="attribute6"  class="attributeinput" size="40" value="" /><script language="Javascript" type="text/javascript">addFieldToCheck("attribute6","State");</script></td></tr>

		<tr><td><div class="required">Postal Code</div></td></tr>
		<tr><td class="attributeinput"><input type="text" name="attribute7"  class="attributeinput" size="40" value="" /><script language="Javascript" type="text/javascript">addFieldToCheck("attribute7","Postal Code");</script></td></tr>

		<tr><td><div class="required">Country</div></td></tr>
		<tr><td class="attributeinput"><!--0-->
		<select name="attribute3" class="attributeinput">
			<option value="1">Afghanistan</option>
			<option value="2">Albania</option>
			<option value="3">Algeria</option>
			<option value="4">American Samoa</option>
			<option value="5">Andorra</option>
			<option value="6">Angola</option>
			<option value="7">Anguilla</option>
			<option value="8">Antarctica</option>
			<option value="9">Antigua and Barbuda</option>
			<option value="10">Argentina</option>
			<option value="11">Armenia</option>
			<option value="12">Aruba</option>
			<option value="13">Australia</option>
			<option value="14">Austria</option>
			<option value="15">Azerbaidjan</option>
			<option value="16">Bahamas</option>
			<option value="17">Bahrain</option>
			<option value="18">Bangladesh</option>
			<option value="19">Barbados</option>
			<option value="20">Belarus</option>
			<option value="21">Belgium</option>
			<option value="22">Belize</option>
			<option value="23">Benin</option>
			<option value="24">Bermuda</option>
			<option value="25">Bhutan</option>
			<option value="26">Bolivia</option>
			<option value="27">Bosnia-Herzegovina</option>
			<option value="28">Botswana</option>
			<option value="29">Bouvet Island</option>
			<option value="30">Brazil</option>
			<option value="31">British Indian Ocean Territory</option>
			<option value="32">Brunei Darussalam</option>
			<option value="33">Bulgaria</option>
			<option value="34">Burkina Faso</option>
			<option value="35">Burundi</option>
			<option value="36">Cambodia</option>
			<option value="37">Cameroon</option>
			<option value="38">Canada</option>
			<option value="39">Cape Verde</option>
			<option value="40">Cayman Islands</option>
			<option value="41">Central African Republic</option>
			<option value="42">Chad</option>
			<option value="43">Chile</option>
			<option value="44">China</option>
			<option value="45">Christmas Island</option>
			<option value="46">Cocos (Keeling) Islands</option>
			<option value="47">Colombia</option>
			<option value="48">Comoros</option>
			<option value="49">Congo</option>
			<option value="50">Cook Islands</option>
			<option value="51">Costa Rica</option>
			<option value="52">Croatia</option>
			<option value="53">Cuba</option>
			<option value="54">Cyprus</option>
			<option value="55">Czech Republic</option>
			<option value="56">Denmark</option>
			<option value="57">Djibouti</option>
			<option value="58">Dominica</option>
			<option value="59">Dominican Republic</option>
			<option value="60">East Timor</option>
			<option value="61">Ecuador</option>
			<option value="62">Egypt</option>
			<option value="63">El Salvador</option>
			<option value="64">Equatorial Guinea</option>
			<option value="65">Eritrea</option>
			<option value="66">Estonia</option>
			<option value="67">Ethiopia</option>
			<option value="68">Falkland Islands</option>
			<option value="69">Faroe Islands</option>
			<option value="70">Fiji</option>
			<option value="71">Finland</option>
			<option value="72">France</option>
			<option value="73">France (European Territory)</option>
			<option value="74">French Guyana</option>
			<option value="75">French Southern Territories</option>
			<option value="76">Gabon</option>
			<option value="77">Gambia</option>
			<option value="78">Georgia</option>
			<option value="79">Germany</option>
			<option value="80">Ghana</option>
			<option value="81">Gibraltar</option>
			<option value="82">Great Britain</option>
			<option value="83">Greece</option>
			<option value="84">Greenland</option>
			<option value="85">Grenada</option>
			<option value="86">Guadeloupe (French)</option>
			<option value="87">Guam (USA)</option>
			<option value="88">Guatemala</option>
			<option value="89">Guinea</option>
			<option value="90">Guinea Bissau</option>
			<option value="91">Guyana</option>
			<option value="92">Haiti</option>
			<option value="93">Heard and McDonald Islands</option>
			<option value="94">Honduras</option>
			<option value="95">Hong Kong</option>
			<option value="96">Hungary</option>
			<option value="97">Iceland</option>
			<option value="98">India</option>
			<option value="99">Indonesia</option>
			<option value="100">Iran</option>
			<option value="101">Iraq</option>
			<option value="102">Ireland</option>
			<option value="103">Israel</option>
			<option value="104">Italy</option>
			<option value="105">Ivory Coast (Cote D'Ivoire)</option>
			<option value="106">Jamaica</option>
			<option value="107">Japan</option>
			<option value="108">Jordan</option>
			<option value="109">Kazakhstan</option>
			<option value="110">Kenya</option>
			<option value="111">Kiribati</option>
			<option value="112">Kuwait</option>
			<option value="113">Kyrgyzstan</option>
			<option value="114">Laos</option>
			<option value="115">Latvia</option>
			<option value="116">Lebanon</option>
			<option value="117">Lesotho</option>
			<option value="118">Liberia</option>
			<option value="119">Libya</option>
			<option value="120">Liechtenstein</option>
			<option value="121">Lithuania</option>
			<option value="122">Luxembourg</option>
			<option value="123">Macau</option>
			<option value="124">Macedonia</option>
			<option value="125">Madagascar</option>
			<option value="126">Malawi</option>
			<option value="127">Malaysia</option>
			<option value="128">Maldives</option>
			<option value="129">Mali</option>
			<option value="130">Malta</option>
			<option value="131">Marshall Islands</option>
			<option value="132">Martinique (French)</option>
			<option value="133">Mauritania</option>
			<option value="134">Mauritius</option>
			<option value="135">Mayotte</option>
			<option value="136">Mexico</option>
			<option value="137">Micronesia</option>
			<option value="138">Moldavia</option>
			<option value="139">Monaco</option>
			<option value="140">Mongolia</option>
			<option value="141">Montserrat</option>
			<option value="142">Morocco</option>
			<option value="143">Mozambique</option>
			<option value="144">Myanmar</option>
			<option value="145">Namibia</option>
			<option value="146">Nauru</option>
			<option value="147">Nepal</option>
			<option value="148">Netherlands</option>
			<option value="149">Netherlands Antilles</option>
			<option value="150">Neutral Zone</option>
			<option value="151">New Caledonia (French)</option>
			<option value="152">New Zealand</option>
			<option value="153">Nicaragua</option>
			<option value="154">Niger</option>
			<option value="155">Nigeria</option>
			<option value="156">Niue</option>
			<option value="157">Norfolk Island</option>
			<option value="158">North Korea</option>
			<option value="159">Northern Mariana Islands</option>
			<option value="160">Norway</option>
			<option value="161">Oman</option>
			<option value="162">Pakistan</option>
			<option value="163">Palau</option>
			<option value="164">Panama</option>
			<option value="165">Papua New Guinea</option>
			<option value="166">Paraguay</option>
			<option value="167">Peru</option>
			<option value="168">Philippines</option>
			<option value="169">Pitcairn Island</option>
			<option value="170">Poland</option>
			<option value="171">Polynesia (French)</option>
			<option value="172">Portugal</option>
			<option value="173">Puerto Rico</option>
			<option value="174">Qatar</option>
			<option value="175">Reunion (French)</option>
			<option value="176">Romania</option>
			<option value="177">Russian Federation</option>
			<option value="178">Rwanda</option>
			<option value="179">S. Georgia &amp; S. Sandwich Isls.</option>
			<option value="180">Saint Helena</option>
			<option value="181">Saint Kitts &amp; Nevis Anguilla</option>
			<option value="182">Saint Lucia</option>
			<option value="183">Saint Pierre and Miquelon</option>
			<option value="184">Saint Tome and Principe</option>
			<option value="185">Saint Vincent &amp; Grenadines</option>
			<option value="186">Samoa</option><option value="187">San Marino</option>
			<option value="188">Saudi Arabia</option>
			<option value="189">Senegal</option>
			<option value="190">Seychelles</option>
			<option value="191">Sierra Leone</option>
			<option value="192">Singapore</option>
			<option value="193">Slovak Republic</option>
			<option value="194">Slovenia</option>
			<option value="195">Solomon Islands</option>
			<option value="196">Somalia</option>
			<option value="197">South Africa</option>
			<option value="198">South Korea</option>
			<option value="199">Spain</option>
			<option value="200">Sri Lanka</option>
			<option value="201">Sudan</option>
			<option value="202">Suriname</option>
			<option value="203">Svalbard and Jan Mayen Islands</option>
			<option value="204">Swaziland</option>
			<option value="205">Sweden</option>
			<option value="206">Switzerland</option>
			<option value="207">Syria</option>
			<option value="208">Tadjikistan</option>
			<option value="209">Taiwan</option>
			<option value="210">Tanzania</option>
			<option value="211">Thailand</option>
			<option value="212">Togo</option>
			<option value="213">Tokelau</option>
			<option value="214">Tonga</option>
			<option value="215">Trinidad and Tobago</option>
			<option value="216">Tunisia</option>
			<option value="217">Turkey</option>
			<option value="218">Turkmenistan</option>
			<option value="219">Turks and Caicos Islands</option>
			<option value="220">Tuvalu</option>
			<option value="221">Uganda</option>
			<option value="222">Ukraine</option>
			<option value="223">United Arab Emirates</option>
			<option value="224">United Kingdom</option>
			<option value="225">United States</option>
			<option value="227">Uruguay</option>
			<option value="226">USA Minor Outlying Islands</option>
			<option value="228">Uzbekistan</option>
			<option value="229">Vanuatu</option>
			<option value="230">Vatican City State</option>
			<option value="231">Venezuela</option>
			<option value="232">Vietnam</option>
			<option value="233">Virgin Islands (British)</option>
			<option value="234">Virgin Islands (USA)</option>
			<option value="235">Wallis and Futuna Islands</option>
			<option value="236">Western Sahara</option>
			<option value="237">Yemen</option>
			<option value="238">Zaire</option>
			<option value="239">Zambia</option>
			<option value="240">Zimbabwe</option>
			</select>
			</td>
		</tr>
		
		<tr><th><div class="attributename">Phone Number</div></th><td class="attributeinput">
        <input type="text" name="attribute14"  class="attributeinput" size="40" value="+61 3 92520605"></input></td></tr>

		<tr><td><div class="attributename">Order Quantity</div></td></tr>
		<tr><td class="attributeinput"><input type="text" name="attribute10"  class="attributeinput" size="40" value=""></input></td></tr>
		</table>
		<input type="hidden" name="list[1]" value="signup" /><input type="hidden" name="listname[1]" value="Distributors"/><div style="display:none">
		<input type="text" name="VerificationCodeX" value="" size="20" /></div><p><input type="submit" name="subscribe" value="Register Interest" onClick="return checkform();" /></p>
    </form>
	

	</body>
</html>


