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Reseller Application

Company
First Name
Last Name
Title
Phone
Email
Website
Street Address
City
State / Province / Region
ZIP / Postal Code
Country
Years in Business
Business Type
Distributors
Which distributors do you purchase from (click all that apply)
Distribution #
Provide one distributor name and account # (used to verify reseller status)--or type NONE
Classification
How would you classify your company? (check all that apply)
Verticals
Select vertical markets you concentrate and specialize in (check all that apply)
Prior Year Revenue
Projected Revenue
Anticipated revenues this year
% of your business is Hardware
% Services
Percentage business is Services
Geography
What geographical area(s) do you serve (check all that apply)
Total # Employees
# Inside Sales
# Outside Sales
# Engineers
Relationships & Certifications
Please list primary vendors you have a formal relationship with (reseller agreements). Include key certifications.
Similar or Complimentary Products
List other products you work with that are similar or complimentary to Company products.
Value Added Services
Provide a description of your primary Value Added services (integration, training, custom development, consulting, etc.)
Date
Select todays date
Reseller Agreement (please read)