Reseller Registration

Please complete this form to apply as a Bugscore 360 partner.
Please call us at +44 7729 643 720 or (512)333-1279 if you have any questions.


Personal Details


Username

Password

First Name

Last Name

Address

Zip Code

City

Country

State

Website

E-mail

Phone Number

Fax #


Company Details

Company Name

Years in business


Business Type

Corporation

Partnership

Proprietor   

Other


Which Distributor(s) do you purchase from:

Ingram Micro

Tech Data    

D&H            

Navarre        

GE Access  

Other (list):

How would you classify your company?

Reseller          VAR             Sys Integrator     

Consultant      Developer      OEM

Chain             Franchise      Training

E-commerce   Distributor     Mail Order

Select vertical markets you "concentrate" on and specialize in - check all that apply

Government      Education        Fortune 500  Accounting      Advertising       Aviation / Aero

Automotive       Chemical         Construction Development    Entertainment  Food

High Tech         Health Care      Insurance     Library            Publishing        Real Estate

Security           Training            Travel           Other:


Prior year annual revenue

Projected revenue this year


Percentage of revenue (totals 100%)


Hardware

Software

Services


What geographical area do you serve?


 Local (50 mile)

 State wide       

 Regional         

 National          

 International    


Total # of employees

# Inside sales

# Outside sales

Other:

Indicate which types of marketing activities you engage in:

Seminars

Newsletters

Trade Shows

Direct Response

Print Ads

Webinars

Online Rich Media

 

                                


Relationships, Certifications

Please list other primary vendors you have a formal (reseller agreements) relationship with. Include key certifications.

Please provide a description of your primary “value added” services (integration, training, custom development, etc.)

What other products do you sell that are similar or complimentary to Bugscore360?

Reseller Agreement (please read) (opens in its own window)



By submitting this form, I agree to the terms of the reseller agreement.