SUPEReseller Registration Form

There are two sections for SUPEReseller Registration.

Section 1 of 2: "Contact Information" Please fill in the following contact information.

Contact Information

Name:

Phone:

Email:
Company Name:

Fax:
Purchasing Contact

Name:

Phone:

Email:
Address:

City:

State:

Zip:
Accounting Contact

Name:

Phone:

Email:
Address:

City:

State:

Zip:
Company Information

No. of Employees:

No. of Sales Representatives:
Annual Revenue:
Please indicate % of total revenue by the following product types:

Memory:

Preferred Brand:
Hard Drives:

Preferred Brand:
Flash Drives:

Preferred Brand:
Digital Media:

Preferred Brand:

Section 2 of 2: "Preferences" Please select your preferences.

Preferences

Do you prefer to receive your 3% SUPEReseller rebate in the form of a MDF (Marketing Development Fund) or
VIR (Volume Incentive Rebate)?:
All MDF activities must be approved by
EDGE Tech Corp's Director of Marketing.
Do you want to pass through EDGE product rebates to your end-users?:
Please list your primary distributor partner:
Please list your secondary distributor partner:

Need help? If you have questions, please call 1-800-259-8989 x2048. EDGE Tech Corp

Purchasing Contact