luidia.com | resellers
eBeam Reseller Application Simply complete the form below and click on the button at the end of the form. We will contact you upon review of your application (usually within 10 business days).
Required fields* are noted with a star.
Company* Address* City State Postal Code Country* Phone* Extension Fax Email* Website URL
Company Address City State Postal Code Country Phone Extension Fax
*Company Type Select One Corporation Partnership Sole Proprietorship
*Business Type Select One VAR Retail Dealer Retail Store E-Retailer System Integrator Consultant Other (Please specify)
Date established *Federal Tax ID#
What vertical markets do you serve?
Primary
Secondary
Education Financial Health High Tech Government Insurance Legal Publishing/Graphic Arts Real Estate Other
What other services do you provide?
Consulting Service Contracts Training Installation Tech Support Other
Name
Title
Phone
Email
Sales
Marketing
Technical Support
Training
Last year total sales revenue $
Current year total sales revenue $
Number of employees
Number of sales reps
Estimated monthly eBeam unit volume
Do you currently sell similar product? If yes, which products?
Do you currently sell whiteboard products? If yes, which products?
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