1. Tell Us About You

Disclaimer: All information collected in this application will for Internal Samsung Electronics America (SEA) use only and only for the purpose of your application to the ISP Partner Program.

* Required

Are you currently providing*

Repair Service Only Both Product Resale and Repair Service

Are you an organization that provides self-servicing maintenance for Samsung products?*
(e.g. K-12 or higher education institutions, corporations or any other types of organization that have a business maintenance team)

Yes No

What product types do you currently handle?*(Select all that apply)

Home Appliances (Samsung Branded)

Home Appliances (Dacor Branded)

Visual Display/TV/ Entertainment

Handheld Phones

Note PC

Tablet

2. Basic Profile

Company Name*

Current Position*

First Name*

Middle Name

Last Name*

Email*

Confirm Email*

Phone*

Doing Business AS (dba)

Form of Legal Entity*

State of Incorporation*

Business Address

Street 1*

Street 2

City*

State*

Zip Code*

5. Comments and Questions

Please let us know when is the best day and time to contact you (e.g. 9:00 AM, Wednesday-Friday)

Were you referred by a Samsung representative or have you had direct contact with a Samsung representative?*

Yes No

If you were referred by a Samsung representative, please provide their name, otherwise write N/A.

Additional Comments

6. Application Summary

**Please check and edit any incorrect data in the summary before submitting your application.**

[Basic Profile]

Name of Company :
Current Position :
First Name :
Middle Name :
Last Name :
Email :
Phone :
Street 1 :
Street 2 :
City :
State :
Zip :

[Company Information]

Please provide the name of the distributor or wholesaler from whom you are purchasing Samsung products :
What other manufacturers products are you selling :
What is the average annual Samsung product sales volume :

Business Days :
Business Hours (Weekdays) :
~
Business Hours(Weekends/Holidays) :
~
Is there Admin staff in your company? :
Number of Admin Staffs :
Is there a parts manager in your company? :
Is there an accounting manager in your company? :
Do you sell refurbished goods? :
List the names of the manufacturer that you are authorized to service :
List the names of the manufacturers where you received Factory Training :

[Service Capabilities]

Service Provided :
Self-service maintenance for Samsung products :
Serviced Product Groups :

Are your technicians trained and certified for R600 Seal System ? :
Do they have Lokring tools ? : Comments :
Do you own a microwave leak meter? :

Are any of your technicians certifised with WISE? :
Do you own a store certified with WISE? :

How long has your company been in business? :
Previous Samsung repair authorization history? :
Number of technicians :
What is the average technician's experience? :
What is the approximate size of your facility? :
What is your coverage area? (e.g. zip codes) :
How many Samsung repairs do you make each month? :
How many company vehicles do you operate? :
What is the type of the vehicle? :
Do you have service performance tracking system in place? :
List all available S/W or devices :

[Comments and Questions]

Best time for us to contact you :
Were you referred by Samsung representative or do you have a direct contact at Samsung? :
If you were referred by a Samsung representative, please provide their name, otherwise write N/A :
Additional Comments :

You must agree to below statements to submit your application:

I agree to the terms and conditions of this application and confirm all information entered is correct. Samsung will NOT BE HELD LIABLE for PROCESSING MY APPLICATION based on incorrect or incomplete information provided by me.

I authorize Samsung to disseminate and circulate all information provided herein to process and review qualification within Samsung Electronics America and outside institutions such as credit bureaus.

Apply for Independent Service Provider with Samsung

1. Tell Us About You

2. Basic Profile

Business Address

3. Company Information

4. Service Capabilities

Please upload all technician WISE certificates.

Please upload all Store Location WISE certificates.