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Reseller Information Form
What type of reseller do you want to be?
OEM (private label our products for distribution)
Reseller
Referral

General information

Required fields are marked by an asterisk (*)
*Company name:   
Address
City:
State/Province:    
Zip/Postal Code:    
*Country:
Phone:
Fax:
Number of years In Business:
Number of Employees:
Primary Contact:
*Name:
*E-mail:
Technical Contact Name:
Technical Contact's E-mail:

What is your current customer base?

Small Business (1-100 employees)
Medium Business (100-500 employees)
Corporate Accounts

Total Number of Accounts:

*Regions, Area Codes, or Zip Codes Served:

Type of business

VAR
ISP
System Integrator
Retailer
Original Equipment Manufacturer or Software Development
Other


Market Segment Representing your Fastest- Growing Opportunities?

 

Do you have any Marketing Programs in place?

Please Describe: