Reseller Application

  Please complete this form,
  Alternatively or call 073 436 4787

Fields marked with an * are compulsory.

Anticipated Number of Users you will sign up in the:
First Month *	-------- Please Select -------- 10 - 100 Users 200 - 1000 Users 1000 - 5000 Users 5000 - 10000 Users
3 Months *	-------- Please Select -------- 10000 - 20000 Users 20000 - 40000 Users 40000 - 50000 Users 55000 - 100000 Users
12 Months *	-------- Please Select -------- 100000 - 250000 Users 500000 - 550000 Users 550000 - 1000 000
First Name *
Last Name *
Company name (or Sole Trader)
Industry of Current business activities	-------- Please Select -------- Application Development Biometrics Business Intelligence Business/technology incubator Call centres Computer telephony integration Cellular systems & services Consulting Content Management CRM Data centre Data Warehousing Disaster recovery Business continuity E-commerce E-Billing E-learning E-mail Messaging Groupware E-procurement E-marketplace Holding Company Human Resources IT Services Management Knowledge Management Leasing / Rental Network Hardware Managment Office Automation Outsourcing Project Management Retail Technology Point of Sale Systems Security Security/VPN Firewall/Remote Access Service Provider Supply Chain Management Systems Integration Systems Management Telecommunications Training Web Development/Hosting Web Services Wireless Other
Position in your company
Main SA City of operation
Mobile Number: *
Email Address *
Website
Please note that you will within 1 business day set up a test agency for you such that you will have access to the relevant documentation under the downloads section. Please accept any "Invitation" to join or "Welcome" mail which will carry your username and password to have access to the system. Please note that should you agree to continue as an agent then your commissions will be paid out back dated to today. Commissions are discussed in "Revised Agency Agreement" (Appendix A) as can be found in the download section once you have logged in.
I have read the NDA and agree to the terms and conditions of use.
All contact information is considered private and confidential and will not be used in any way other than the intended purpose of this contact form.