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Reseller Application

Please provide the following information. A Colasoft representative will contact you shortly. Fields marked by an '*' are mandatory.

Company Information
Company Name: *
Address: *
City: *
State or Province: *
Country: *
Zip or Postal Code: *
Web Site URL: *

Primary Contact Information
First Name: *
Last Name: *
Title: *
Job Position: *
Email: *
Telephone: *
Fax: *

Reseller Information
Annual revenue: *
Percentage of revenue from hardware sales: % *
Percentage of revenue from software package sales: % *
Will Capsa and nChronos products be listed in your online product offering? *
Yes No
Total number of employees:       *
Number of sales employees:       *
Number of technical employees: *
How will you promote Colasoft products:
*
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