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Becoming a partner starts here!

Thank you for your interest in the PC-Doctor Authorized Reseller program. Complete the following form to apply to become a reseller.

All responses are kept confidential.

First Name:

Last Name:

Phone:

Email Address:

Company Name:

Business Address:

City:

State/Province:

Postal Code:

Country:

Website:

Fax:

Alternate Phone:

If not you, who is the main contact at the company?

Same as above

First Name:

Last Name:

Phone:

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When was your business established? (Required)

Describe the type of businesses you work with.

Will you actively promote our product?

Do you sell to other resellers?

What other types of diagnostic software do you sell?

Please provide any additional comments.

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