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By registering this form you are confirming your interest in participating in the Xerox Personalized Application Builder program, and you agree the information which you are providing will be used to shape the program and communicate with you regarding program events and activities.
First Name: 
Last Name: 
Job Title 
Email address: 
Country: 
Country dialing code: 
Phone number: 
Mobile number: 
Company name: 
Street address: 
City: 
State: 
Zip/post code: 

Please choose one that applies:
 
 
 
 
 
 
If other, specify 

Who is your channel or agent business manager? 
Your business model:
 
 
 
 
If other, specify 

How much of your business is managed services vs. equipment sales? 

Your company has employees with:
 
 
 
 
If other, specify 

What are your PAB program expectations, and how can Xerox help you?