Cartesian Reseller Order Form
Please fill out and fax or mail this order form to
Cartesian Products, Inc.
Reseller Sales
34 Hyde Ave, Suite 3
Newton, MA 02458
tel and fax: (617) 249-0185
Your credit card will be charged for the reseller cost and any annual minimums as required, and
the purchased materials and end-user license
agreement will be mailed to your customer at the email address
provided below.
Reseller Information
Reseller name: |
____________________________________ |
Company name: |
____________________________________ |
Customer Information
Company name: |
____________________________________ |
Name of contact person: |
____________________________________ |
Contact's company address: |
____________________________________ |
City: |
____________________________________ |
State: |
____________________________________ |
Zip/postal code: |
____________________________________ |
Country: |
____________________________________ |
Contact's telephone number: |
____________________________________ |
Contact's fax number: |
____________________________________ |
Contact's email address: |
____________________________________ |
Product information
Check the product being purchased and enter
associated information.
[ ] | CPC View volume license |
| number of seats: ______________________ |
| Option (check exactly one): |
|
[ ] | create new prepaid account |
[ ] | add to existing account ID: ______________________ |
[ ] | CPC View self-registering installation program |
[ ] | CPC View ax self-registering control |
[ ] | self-registering package (CPC View and CPC View ax) |
[ ] | use previously purchased self-registering installation program or control
(must have been purchased by the same customer) |
|
| |
[ ] | CPC conversion battery - per page |
| number of pages: ______________________ |
| battery ID: ___________________________ |
| |
[ ] | CPC conversion battery - per server |
| number of servers: ______________________ |
| battery IDs: ___________________________ |
| ____________________________________ |
Reseller cost
See reseller price guide.
Reseller cost (US$): |
____________________________________ |
Payment information
Check here ___ to use the payment information recorded with your
reseller registration, or fill out the information below to use an
alternative payment method for this order only:
Cardholder name: |
____________________________________ |
Card number: |
____________________________________ |
Expiration date: |
____________________________________ |
Order authorization
By signature below, I authorize Cartesian Products to charge my
reseller account the reseller cost of this order as well as any
applicable annual minimum charges.
__________________________________ |
Signature of Reseller |
Cartesian Products, Inc.
cpi@cartesianinc.com