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Reseller Information Request

Enter the information below to download the Reseller Partner agreement. Complete the agreement and mail or fax it in according to the instructions in the agreement.

Company Information

*Company

*Industry


Corporate Email

*Website

Phone

Toll-Free Phone

Fax

*Country

*Address

*City			*Province

*Postal Code

*Primary Business

*Primary Sales Region



# of Employees			# of Existing Clients


Annual Revenue
(ex: 3.5MM $CAN)

Company Description (to be displayed on our website)

Internal Contact Information

*First Name			*Last Name

*Position


*Business Email

*Business Phone			Ext.


Business Fax


Comments/Additional Notes