Reseller Application Form

Legal Business Name*

ABN*

Phone Number*

Website

Number of Employees

Company Address

Country*

Street

Address Line 2

City

State

Postal Code

Company Type

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 - Phone*

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

Technical Skills

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

Windows*

C#*

Power Shell*

Microsoft SQL*

Networking*

General Information

Contact Us!

Contact Us!

Reseller Application Form

Technical Skills