ImagineTime, Inc. Software Reseller Application

Please print out the following application and Fax to 828-245-3725, or mail to ImagineTime, Inc. P.O. Box 159, Bostic, NC 28018 Phone 828-248-3121. We will contact you as soon as possible.

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The following questions are designed to help us learn about your company and your qualifications to be an authorized reseller. ImagineTime, Inc. reserves the right to be selective with applicants for authorized reseller status. Complete the pertinent sections and return the application to us along with all required materials. All replies will be kept in strict confidence. ImagineTime, Inc., or the applicant, have the right to terminate the arrangement on 90 days notice of one party to the other.

Company Information

Corporate/Storefront Names(s)

Address

City State/Province Country Zip

Telephone Number Fax Number e-mail address

Government Identification Number Reseller Number

Contact Information

Primary Title

Secondary Title

Accounts Payable Manager

Product Focus Information

Major Emphasis

�Hardware

�Software

�Integration

�CPA/Bookkeeping

�Other__________

Primary Target

� High End (over $20k)

� Middle

� Low End (Under $2k)

Vertical Markets

� Accounting	� Advertising	� Health Care	� Real Estate
� Legal	� Consulting	� Publishing	� Government
� Architecture	� Banking	� Insurance	� Construction

Business Profile

Structure of Business

� Sole Proprietorship	� Partnership (list partners)	� Corporation
Date Business Founded:

Type of Business

� Consultant	� Value Add Reseller	� Corporate MIS
� Retail Storefront	� Telemarketer	� Mail Order
� System Integrator	� Independent Software Vendor	� Other ___________________

Personnel

Number of Employees _________
Inside Sales _____________	Outside Sales ____________
Consulting ______________	Other ________________

Annual Sales

� More than $50 Million	� Between $25 & $49 Million
� Between $10 & $24.9 Million	� Between $5 & $9.9 Million
� Between $1 & $4.9 Million	� Between $500 K & $999K
� Between $100K & $499K	� Under $99K

References (required if you want 30 day credit terms)

Banking Reference

Name of Bank Bank Contact Account Number

Address of Bank Bank Phone Number

Trade References

Company Contact Telephone Number

Company Contact Telephone Number

Distributors

Company Contact Telephone Number

Company Contact Telephone Number

Customer References

Company Contact Telephone Number

Company Contact Telephone Number

Signature

Signature: _________________________________	Date: _____________________
Print Name: ________________________________	Title: _____________________

Please include a copy of your State Sales Tax Permit