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EnergyUnite Reseller Application
Legal Company Name:
*
Contact Person:
*
Company Website
*
Phone:
*
Email:
*
Billing Address:
*
City
*
State:
*
Zip Code:
*
Accounting Contact:
*
Phone:
*
Email:
*
Duns #:
Federal Tax ID
*
Reseller Certificate
Billing Address (if different):
City
State:
Zip Code:
Number of Employees:
*
1-5
6-10
11-25
26-50
51-100
101-250
251-500
500+
Inside Sales People:
1-5
6-10
11-25
26-50
51+
Geographical Coverage:
*
Vertical Markets Served:
*
Yearly Sales Projection (Estimate):
Past Year Sales
*
Projection for This Year
Please describe your business
*
Name:
*
Title:
*
Date:
*
+
Signature:
*
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