South River Technologies
Reseller Channel Partner Program Application

You may complete the form below and submit it to be considered for Certified Reseller 
Channel Partner status. A valid email address is required so that program information 
can be sent to you for consideration.

The completed application should be sent to the Channel Partners Program Office. 
It may be emailed, faxed or sent by postal mail.

South River Technologies, Inc.
Channel Programs Office
PO Box 578
Downingtown PA 19335 US

email: resellers@southrivertech.com
fax: 610-873-9972.
tel: 410-266-0667 x204

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Company Information
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Company Name: 	
Contact Name: 	
Contact Title: 	
Contact Email Address: 	
Company Address: 	
City / Locality: 	
State / Province: 	
Zip / Postal Code: 	
Country: 	
Phone: 	
Fax: 	
Company Web Site:
	
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Business Details
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Year Founded: 	

Total Number of Employees: 	

Business Type: 	
____Corporation
____Partnership
____Sole Proprietor
____Other: 

Company Classification: (select all that apply) 	
____Reseller		____VAR
____System Integrator	____Consultant
____Education 		____OEM
____Developer 		____Franchise
____Distributor		____Mail Order
____Other:	

Vertical Markets Served: (select all that apply) 	
____Education		____Government
____Financial Services	____Legal
____Retail 		____Manufacturing
____Telecommunications / ISP
____Other: 

Geographic Markets Served: (select all that apply) 	
____Local
____Regional
____National
____International

Anticipated Annual Volume of SRT Licenses: 


Previous Fiscal Year Revenue % Breakdown:
Software: ____ %
Hardware: ____ %
Services: ____ %

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Current Product Interest
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Products interested in: (select all that apply) 	
____WebDrive
____Titan FTP Server
____GroupDrive Collaboration Suite

Time frame for purchase: 
____Immediately
____2 - 4 Weeks
____1 - 3 Months
____No immediate purchase needs

Seats / licenses required : 	
____1 - 10
____11 - 50
____51 - 100
____101 - 1000
____1000 +
____Enterprise / Unlimited

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Company Departmental Contact Information
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Accounting Contact: 	
Phone: 	
E-mail Address: 	

Purchasing Contact: 	
Phone: 	
E-mail Address: 	

Sales Contact: 	
Phone: 	
E-mail Address: 	

Technical Contact: 	
Phone: 	
E-mail Address: 	

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Marketing and Expected Use Information
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1. How do you plan to market SRT applications? Will you post SRT product logos or links to the SRT web site on your web site?


2. Are SRT applications to be integrated with a new or existing service or product? Please describe the service or product.


3. Are you able to respond to customer inquiries for local reseller pricing that are forwarded from our office?


4. Will you process software only sales to local end users? Do you have any order minimums or restrictions? 


5. Is your technical point of contact able to provide 1st level support of SRT applications for your customers?


6. How did you become aware of SRT applications? Which search engine did you use to find us? What search words did you use? 


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Comments: