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Reseller sign up form
 
ABOUT YOUR COMPANY
      Company name
      Pres/Owner/Partner
Type of business Corporation
Partnership
Sole Proprietorship
      Number of employees
      Year established
Reseller category Computer store
VAR
Consultant
Catalog house
OEM
Other
      Sales volume (current year)
      Types of products sold
Purchase orders required? Yes
No
      Persons authorized to purchase

COMPANY BILLING ADDRESS
      Billing Address
      City
      State
      Zip
      Country

COMPANY SHIPPING ADDRESS
      Shipping Address
      City
      State
      Zip
      Country

MARKETING INFORMATION
      Geographic area served
Do you sell to dealers? Yes
No
If yes, select percentage
Do you sell to end-users? Yes
No
If yes, select percentage
Do you sell to specific vertical markets? Yes
No
Do you have an advertising program? Yes
No
      If so, what is your ad budget?
      Other manufacturers' KVM switches
      Brand and models
      Rose products sales volume anticipated next 12 months
      Number of technical support staff
Do you have repair facilities? Yes
No
Do you have other locations? Yes
No
If yes, list other location(s) personnel, address, phone and fax

ABOUT YOU
      Your name
      Your title
      Name of Rose contact
Where did you hear about Rose Electronics? Referral
Trade Show
Magazine Ad
Magazine Article
Web site
Other
      If other, specify where

HOW CAN WE REACH YOU?
      Telephone
      Fax
      E-mail

ANY COMMENTS OR QUESTIONS?
Comments or questions

 
When finished, click on SUBMIT button below


  

This form is an application, not an approval of Reseller status. Rose Electronics reserves the right to refuse Reseller status to any companies or individuals that do not meet minimum Reseller qualifications.

 


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