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Monday - September 6, 2010
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Reseller Application
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If you believe your firm qualifies, please fill out our short form and we will contact you to discuss the application and explore the possibility of becoming a certified MTICS.
Note
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- means the field is required.
General Information
Company Name
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DUNS No.
Reseller Tax ID No.
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Address
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Suite or Unit No.
City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
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Telephone No.
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Fax
Contact Email Address
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Other Email Address
Address of Web Site
Description of Your Business
Years in business
Less than a year
1 to 5 years
5 to 10 years
More than 10 years
Business Type
Sole Proprietorship
Partnership
Corporation
Length of time at the above address
Less than a year
1 to 5 years
5 to 10 years
More than 10 years
Number of branches/outlets
What geographic region do you serve ?
Approximate gross annual sales
Which best describes your firm's primary business
Systems Intergrator
Distributor
Valued Added Dealer/Reseller
Cash Register Dealer
Systems/Software Consultant
Ecommerce Specialist
Other
List your top (3)
Hardware Vendors
-- (1)
(2)
(3)
List your top (3)
Software Vendors
-- (1)
(2)
(3)
Which MTI™ Certified Solution Provider Program are you applying for ?
MTICS: No Financial Commitment
MTI™ Agent: No Financial Commitment
Silver Program: Financial Commitment
Gold Program: Financial Commitment
Please tell us anything we may need to know about your business and your goals.
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M i c r o T e c h n o l o g y I n t e r n a t i o n a l , I n c . A l l R i g h t s R e s e r v e d