Reseller Program Application

Resellers Program Application

Program Level	VAR/SI/ASP ISP Referral
Company Name
DBA Name
Telephone Number
Fax
Street Address
PO Box
City
State/Province
Zip Code
E-mail Address
Internet URL
Contact Name & Title
Are you currently reselling or planning to resell any other provider's DSL Products? (If yes, please identify the organization with which you are working):

Years operating as named business:
Resale number or seller's permit:
Total number of employees:
# of full-time inside sales people:
Outside sales people:
Technical support:
Software development:
Current annual sales volume:
% HW:
%SW:
%Service:
Last FY sales volume:
Describe the primary markets (horizontal and/or vertical) your organization serves:

Describe the primary application areas you support:

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