ProVu - Reseller Information Form

Company Details

Name of Company:

Trading name:

Registered Address:

Postcode:

Telephone no:

Fax no:

Website:

Email:

No of years Trading:

Type of Organisation:
PLC
Ltd Company
Sole Trader
Partnership
Other

Approximate no of employees:
0-10
10-50
50-100
100+

Nature of Business:
VAR
Service Provider
Consultant
E-tailer
Distributor
Other

Please give a brief description of your current line of business:

Markets Served:
Home User
SOHO
SME
Large Enterprise
Other

Which of the following products do you currently offer to your customers?:
ATAs
Gateways
IP Phones
Video Phones
Routers
WiFi Phones
IP PBX
Headsets

Would you be interested in receiving further information on our "ProSys" on-line fulfilment and provisioning services?
Yes
No

Your Details
Your name:

Contact number:

Email address:

Your position in the company:

Sales contact details
Contact name:

Email:

Contact number:

Purchasing/Account's contact details
Contact name:

Email:

Contact number:

Thank you for taking the time to complete this form. A member of our reseller support team will be in contact with you shortly.