Reseller Application Form

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Azalea Reseller Application

To apply to become an Azalea Reseller Partner, please fill out all fields of the form below.
Please allow up to 2 weeks for us to process your application.

(Required Fields Denoted by *)

Company Information
* Company Name:
* Address 1:
Address 2:
* City:
* State/Province:
* Zip/Postal Code:
* Country:
* Phone:
* Fax:
* Website:

Sales Contact
* Name:
* Title:
* E-mail:
* Phone:

Technical Contact
* Name:
* Title:
* E-mail:
* Phone:

Company Profile
* Year Company established:
* Number of office locations:
* Territory served:
* Total number of employees:
* Number of sales representatives:
* Approximate 2007 sales ($US)?:
* What is your company's business model?: Value added reseller System integrator Service provider/ISP Distributor OEM Other (please specify )

* What is your company's vertical market focus?:

* Wireless products you have sold:

* Current products you sell/deploy:

* Please list several reference accounts:

* VAT/Tax ID:

Technical Expertise

* Number of engineers/technicians on staff?:

* Do you provide network design services?:
Yes
No

* Do you provide installation services?:
Yes
No

* Technical Certifications obtained:

* What days and hours do you provide customer support services?:

Additional Information
* What unique value-add do you offer your customers?:
* Why are you interested in becoming an Azalea partner?:
* How did you hear about Azalea Networks?:
* Any additional comments or questions?:

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