Company Name:


Contact Name:


Title:


Address:


Address (line 2):


City:


State/Province:
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Postal Code:


Country:


Phone:


Email Address:


How many years has the company been in business?


Website Address:


How many products do you want us to carry?


Where is your warehouse located?
(state, country)

Can products ship the same day we order them?
Yes
No

How can we place orders with your company?
Fax to:
Email to:
Phone:

What payment method(s) do you accept?
Credit card
Purchase order (net 30 terms)

Can we dropship orders directly from your warehouse to our customer?
Yes
No

Do you offer download versions (ESD) for your products?
Yes
No

Do you currently offer academic pricing?
Yes
No

Do you currently have academic resellers?
Yes
No

Is volume (or site) licensing available for your products?
Yes
No

Are you willing to provide a link from your website referring academic customers to our website?
Yes
No

Do you also offer academic discounts to any of the following?
Non-profits (501c3)
Government
International students/teachers

Are you interested in any of the following?
Catalog advertising
Email blasts

Questions and Comments: