Reseller Application

Contact Information

Company Classification

Years in Business                Business Type     Corporation     Partnership     Proprietor

Which distributor(s) do you purchase from:
              Ingram Micro     Tech Data     D&H     Navarre     GE Access     Douglas Stewart
         Other:

Please provide one distributor account # (used to verify reseller status)
Name: Number:

How would you classify your company? (check all that apply)

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

Prior year annual revenue:
Projected this year:

Percentage of revenue (totals 100%):    Hardware    Software    Services

What geographical area do you serve?     Local (50 miles)     State wide     Regional      National     International

Total # of employees    # Inside sales    # Outside sales    # Engineers

Indicate which types of marketing activities you engage in:     Seminars     Newsletters     Trade Shows     Direct Response     Print Ads    Other:

Relationships, Certifications

Please list other primary vendors you have a formal (reseller agreements) relationship with. Include any 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 Alpha Five?
    Access     FileMaker     MySQL     DB2     Oracle     Lotus Notes
   Other (list):

By submitting this form, I agree to the terms of the Reseller Agreement.

Contact our Partner Manager if you have problems submitting this form, or you have any questions.