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Reseller Application

Title *
First Name *
Last Name *
Telephone *
Fax
E-mail *
Company
*
Address
*
City
*
State/Province
*
Country
Zipcode
*
Website
*
Organization Type * Example: Sole Proprietor/ Prv Ltd / Co. /Sdn Bhd etc
Nature of Business * Example: Retail Store Front/ Supplier / Reseller / Distributor etc
Others, Please Specify
How many months/years is business established?
How many branches does your company have?
How many resellers does your company have?
Previous Year Sales Revenue
Do you assemble your own PCs, Please check if you do.
Do you provide networking solution?
Number of PCs Sold per Month
Number of Employees
Total Amount of Sales per Year
Number of Technicians
Security Code
*

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