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Reseller Partner Application

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Please complete this form to apply as a Airvine Reseller partner. Call (408) 320-2232 if you have any questions. Thanks.

Reseller Application

Step 1 of 3

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Company*
Name*
First Last
Title*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Website*

Years in Business*
Business Type*
- Proprietor
- Partnership
- Corporation
Distributors
Which distributors do you purchase from (click all that apply)
- WAV. - USA
- Purdicom - UK
- NOWIRE - Nordic region
- Tek-Mart - Mexico
- Ingram Micro
- Tech Data
- D & H
- Navarre
- Douglas Stewart
- Other - please list below
Other Distributor
List any other distributors not on list.
Distibution #
Provide one distributor name and account # (used to verify reseller status)--or type NONE.
Classification*
How would you classify your company? (check all that apply)
- Retailer
- VAR
- System Integrator
- Consultant
- Distributor
- OEM
- Developer
- Chain or Franchise
- Training
- Mail Order
- E-Commerce
- MSP
Verticals*
Select vertical markets you concentrate and specialize in (check all that apply)
Prior Year Revenue*
General estimate
Projected Revenue*
Anticipated estimated revenues this year?
% Hardware*
% of your business is Hardware
% Software*
% of your business is Software
% Services*
Percentage business is Services
Geography*
What geographical area(s) do you serve (check all that apply)
- Local (50 mile)
- State Wide
- Regional (multiple states)
- National
- International
Total # Employees*
# Inside Sales*
# Outside Sales*
# Engineers*

Relationships & Certifications*
Please list primary vendors you have a formal relationship with (reseller agreements). Include key certifications.
Similar or Complimentary Products*
List other products you work with that are similar or complimentary to Company products.
Value Added Services*
Provide a description of your primary "Value Added" services (integration, training, custom development, consulting, etc.)
Date
Select today's date
MM slash DD slash YYYY
Reseller Agreement (please read)
Click HERE to view the Partner Agreement (opens in its own window). Please email or call the Director of Partnerships if you have any questions. By submitting this form, I agree to the terms of the reseller agreement.
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Name
This field is for validation purposes and should be left unchanged.

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Phone

(408) 320-2232

EMAIL

partner@airvine.com

Address

1500 Wyatt Dr, Suite #9
Santa Clara, CA 95054

Business Hours

Open 8 am – 5 pm (PST)
Monday – Friday

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