RESELLER APPLICATION

Fill in the form below and click submit.
All information submitted becomes property of MiniX.
Please note that only qualified resellers will be contacted.

 

Company Profile Information (Items in RED are required)

Seller's Permit or Reseller ID:

Company:

Address:

 

Suite #:

City:

State:

Zip:

Phone:

Fax:

Web Site URL:

Business Channel Type

Please check one

 Integrator
 Developer
 VAR
 Storefront
Brief description of your business

Product Focus (Check all that apply)

Check all that apply

 Personal
 Education
 Server
 Government
Other (please describe)
Contact Information

Name:

Title:

Email:


Business Structure and Background

Date business established:

/ /

Organization Type:

Sole Proprietorship
 Partnership
 Corporation

Number of Employees:

Target Sales Territory:

Local
 Regional
 National

Sales Revenue:

$0 - $100k
 $100k - $500k
 $500k - $1m
 $1m - $5m
 $5m - +

Revenue Breakdown:

% Revenue from System
 % Revenue from Software
 % Revenue from Components & Peripherals
 % Revenue from Service & Support

Target Market(s)

Horizontal Markets:

Wide Area Networks
 Internet / Intranet
 Local Area Networks
 RDBMS Applications
Other (please describe)
Other Sales Locations

City:

State:

City:

State: