Reseller & Distributor Application

Thank you for your interest in becoming a Servprise^® reseller. To receive information regarding reselling, please complete the form fields below.

Name: * Company: Country: * Street Address: * Street Address (Cont.): City: * State/Province: * Zip Code: * Phone Number:

E-Mail Address: *

Company Information

Number of Employees: Number of Sales People: Geographic area you're equipped to serve: Annual Sales:

< $1 Million	$3 - 5 Million	$10 - 20 Million	$50+ Million
$1 - 3 Million	$5 - 10 Million	$20 - 50 Million

Customer Focus:

Small Business (< 100 employees)	Medium Business (100 - 999 employees)	Large Business (1000+ employees)
Federal Government	Local/State Government	Other:

Revenue Sources:

Hardware	Training	Consulting
Software	Installation	Other:

Which product lines are you interested in selling?

WebReboot Line	WebReboot Enterprise Line	WebReboot Enterprise Accessories
WebReboot 3.0 (8 port)	WebReboot Enterprise (24 port)	WebReboot Advanced Server Card
	WebReboot Enterprise (48 port)	WebReboot Power Cycle Module
	WebReboot Enterprise (80 port)

Other vendors of products sold by your organization: