Become a Reseller Form
1. Company Name
2. Company Website
3. Company Address (Address Line 1, Address Line 2, City, State, Country, Post Code)
4. Company Phone Number
5. Title, Your Name, Your Surname
6. Email Address
7. Your Direct Contact Number (Phone Number, Extension number)
8. Your Position at Company
9. How many years have you been trading?
10. Your Major Market
--- Please Select ---
Retail
Hospitality/Restaurant
Medical
Industry
Gaming
Government
Industrial
Friends/Family, Others
11. Your Primary Hardware Distributor
12. POS Manufacturers You Resell
13. How many hardware installations projected on a monthly basis?
14. How did you hear about JollyPOS
--- Please Select ---
Event/Exhibution/Conference
Google Search
Retail Reseller News
Social Media (Facebook/Twitter/Linkedin/Youtube)
Employer
Friends/Family, Others
16. Do you have any Enquireies?
17. Newsletter Opt-In
Yes
No