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  e-Surveiller Reseller Partner Application 

If you are interested in becoming an e-Surveiller reseller, fill out the form below and click submit to send us the application and we will contact you within 1-2 business days.

Reseller Profile

Business/Store name: 
 
Contact Person: 
 
Title: 
 
Email Address: 
 
Website: 
 
Mailing Address: 
 
City: 
 
State: 
 
Postal/Zip Code: 
 
Country: 
 
Telephone: 
 
Fax: 
 

Additional Information

Type of Business: 
 
Other (Please Specify): 
 
 
 
 
Additional Business Information:
 
No of years in business: 
 
Annual Sales (USD): 
 
 
 
 
What Platforms do you sell: (Check all that apply) 
 
Windows XP Home, 95, 98, ME  
Windows XP Professional, Server 2003, 2000 Pro, 2000 Server  
Macintosh  
Linux  
Unix  
Other (Please Specify): 
 
   
Major Customer category: (Check all that apply)
 
Fortune 2000/Corporate Sales  
Small Business/Professional  
Programmer/Hobbyist  
Educational  
Government  
Other (Please Specify)  
   
Certifications: (Check all that apply)
 
Microsoft Certified Solution Provider (MCSP)  
Microsoft Certified Technical Education Center (CTEC)  
Novell Platinum Reseller  
Novell Gold Reseller  
General Services Administration Reseller (GSA)  
Apple Authorized Reseller  
Apple Solution Expert  
Other (Please Specify)  
   
Do you currently stock other software products?  
Yes       No    
 
 
Tell us about your business and the products/services you provide  
   
 
     
     
 

 
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