Reseller Application Form

Legal Business Name*

DBA*

Phone Number*

Website

Number of Employees

Region

Company Type

Tax ID*

Target Retail Verticals (Please check all that apply)*

Clothing / Apparel / Accessory

Wine / Beer / Liquor

Gift / Novelty / Souvenir

Sporting Goods

Electronic / Household Appliance Retailers

Hobby / Toy / Games

Nursery / Garden Centers

Wholesale

Pharmacies

Grocery / Supermarkets

Golf Pros / Golf Stores

Camera Stores

Furniture / Home Wares

Shoe Stores

Discount Stores

Ticketing

Primary Contact - Name

Primary Contact - Job Title

Primary Contact - Email

Primary Contact - Years with Company

Secondary Contact - Name

Secondary Contact - Job Title

Secondary Contact - Email

Secondary Contact - Years with Company

POS Software Currently Sold

Other Software Currently Sold

Hardware Partnerships

Payment Processing Partnerships

Please rate your company’s strength in the following technologies.

Windows*

C#*

Power Shell*

Microsoft SQL*

Networking*

General Information