Software Reseller Request Form

First name
Last name
Middle initial
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
URL

Software Products
Select One SmartVideo2000 for Windows SmartStore for Windows SmartDelivery for Windows SmartClean for Windows SmartWholesale for Windows
Select One SmartVideo2000 for Windows SmartStore for Windows SmartDelivery for Windows SmartClean for Windows SmartWholesale for Windows
Select One SmartVideo2000 for Windows SmartStore for Windows SmartDelivery for Windows SmartClean for Windows SmartWholesale for Windows
Select One SmartVideo2000 for Windows SmartStore for Windows SmartDelivery for Windows SmartClean for Windows SmartWholesale for Windows
Select One SmartVideo2000 for Windows SmartStore for Windows SmartDelivery for Windows SmartClean for Windows SmartWholesale for Windows

	BILLING - Select a future payment method
Payment Type	Select One C.O.D. Cashier's Check Check Credit Card Money Order Wire Transfter

	SHIPPING ADDRESS, if different
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
	SHIPPING METHOD
Courier	Select One U.S. Priority Mail U.S. Express Mail UPS Next Day UPS Two Days UPS Ground FedEx Next Day FedEx Two Days