Panicware, Inc.

Reseller Application

Please fill out the form below to sign-up to be a Panicware Authorized Reseller. Upon approval of your submission, you will be issued a reseller account identification number and associated materials, rules and instructions.

Panicware's resellers benefit from having a private login where you may check your sales at any time and have an optional automated email sent to a specified email address each time you receive a sale. This provides you full real-time feedback as to how your campaign and marketing programs are performing!

Reseller Application Form

* indicates a required field

* Contact Person

* Contact Email Address

Company Name

* Address

* City	* State	* Zip/Postal Code

Country

* Phone	Fax

In order to be able to send checks to individuals or companies, we need to have your Tax ID or SSN (Social Security Number).

* Tax ID / SSN

Please enter the URL of the page, or sample page, from which you will be reselling our products. If you do not yet have a page, or are unsure about where you will place the reseller advertisements, simply indicate your company web site.

* URL

Please enter any specific comments or instructions that you would like us to consider or review.

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