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Apply for Reseller
Sign up to become a Polywell reseller, and use our extensive product lineup and expertise to enhance and grow your business!
Please fill out the form below. We will contact you with terms, and User ID / Password (if applicable). To set up terms, you will need to fill out a complete application, which will be sent to you separately.
All information submitted herein becomes the property of Polywell Computers.

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:


Do you already have a sales contact at Polywell?

 

Yes
No

If yes, provide name



        
For further information please call 1-800-999-1278 or 650-583-7222 to speak with a sales rep.

If your viewer does not support FORMS, please print out this form, and fax to 1-650-583-1974. Product Disclaimer: Refer to Polywell "HOME" Page
Copyright 2003 Polywell Computers