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Step 1 of 2
Reseller Application Form
For your application to be considered, this form must be filled out completely and accurately.
You must fill out the sales tax use form
(
Download Here
)
for step 2
.
Company Name:
DBA/Parent Company (name if any):
Please Specify Any Group Affiliations:
Phone:
(
)
-
Ext.
Fax:
(
)
-
Email:
Web Address:
Billing Address
Street Address:
City:
State:
Zip Code:
Shipping Address
Same As Billing
Street Address:
City:
State:
Zip Code:
Country:
United States
Canada
I am registered as a:
Retailer
Wholesaler
Manufacturer
Other - Specify:
at my
Billing Address
Shipping Address
Main Business Activities:
State Sales Permit #:
Established (MM/YY):
/
Past 12 Months' Gross Sales:
Federal Tax ID #:
Number Of Employees:
Percent From Antivirus Software:
%
Ownership:
Sole
Proprietor
Partnership
Corporation - State of Incorporation:
Principle Owner(s):
Authorized Buyers (Name & Title):
How will you purchase your software?
Phone
Email Submission
Fax
Online
IMPORTANT:
Please read the
Antivirus Reseller Agreement
before submitting this form. If you have trouble following this link, please turn off your popup blocking software or allow popups from this site.
I have read and agree to the
Reseller Agreement
.
By clicking 'I Agree' below, I/We agree to pay Walling Data Systems on time, and all goods will remain Walling Data Systems property until fully paid. I/we will pay 10% interest for any invoices unpaid 60 days after due date and also be responsible for any collection cost and attorney fees toward the collection of bad debts and any dispute will take place in a Catawba County, North Carolina Court.
