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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:

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Website:

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Alternate Phone:

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

Same as above

First Name:

Last Name:

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Describe the type of businesses you work with.

Will you actively promote our product?

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What other types of diagnostic software do you sell?

Please provide any additional comments.

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