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Thank you for your interest in selling the MobileDataNow software. To help us understand how best we can work together, please complete the questionnaire below.

Your Contact Details

Your Name: *

Email Address: *

Company Details

Organisation Name: *

Web Address: *

Address 1: *

Address 2: *

City: *

State/Province:

Postcode/zip:

Country: * AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

Phone (including country code): *

Fax (including country code):

Billing Contact Details

If there is one persion who will be dealing with all purchases and purchase enquiries, please list their details here

Name:

Email:

Phone (including country code):

Fax (including country code):

Technical Contact Details

If there is one person who will be dealing with all technical questions relating to MobileDataNow, please list their details here

Name:

Email:

Phone (including country code):

Fax (including country code):

About Your Company

How many employees does your company have?: *

How many customers does your company have?: *

Can you breifly describe what your company does?: *

What industries do you mainly serve?: *

Marketing the MobileDataNow Software

What is your expected method of providing MobileDataNow and related services?:

As part of a consulting engagement

Reselling to customer base

Referring customers to MobileDataNow software

Integerated into existing product(s) (OEM)

Other

If other, please list

Other:

Do you belong to a local user group? If so, which one?:

Which countries do you intend to actively sell MobileDataNow in?: *

Do you have any experience in localising English language products (marketing materials and software interfaces) into other languages? If so, which languages?: *

About the Reseller Program

Do you have a technical and/or Services capabilities document that you distribute to your customers?:

Do you have any other questions or coments?:

Thank you for taking the time to complete our MobileDataNow Reseller Program Questionnaire. While we aim to process your application as quickly as possible, reseller processing may take between 5 to 10 business days.

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