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    • AnswerChat(tm) Reseller/VAR Application

    This is a form for resellersThis account signup is for Reseller/VAR Applicants Only! Please do not fill out this form if you do not meet the minimum requirements below. This is not an account signup form, this is a reseller application. If your Web Site does not make it very clear that you are a VAR/Reseller you will not be approved.

    Basic Requirements to Become a AnswerChat Reseller:

    1. Your site URL is a top-level domain name. We will not accept URLs that are a directory within a domain name such as http://www.site.com/mycompany/ nor do we accept host names such as http://mycompany.bigprovider.com/.
    2. Your site meets the minimum requirements of Alpha Media. ( A minimum of six (6) purchases of AnswerChat must be made per year, by each VAR. )
    3. Your Web Site makes it very clear that you are a Reseller/VAR or in a related field.

    First Name
    Last Name

    Organization Name
    Organization Type
     

    Address 1
    Address2

    City
    State (outside USA do not enter)

    Zip/Postal Code (Required in USA)
    Country
     

    Phone #
    Fax #

    Email Address
    Web Address
     
    If your business is in New York Sate select your county:
    (New York State businesses only)
    Enter a username and password to use for purchasing AnswerChat and viewing your account information.

    Username    		  

    Password
    Verify Password
    Please select one of the following two VAR options:
    20% VAR Discount - With this option you pay us 1 payment each month, for all of your customers (less the 20%) and you will have to bill your customers directly for their AnswerChat service.
    15% VAR Discount - With this option we collect payment from each of your customers for you, and send you a check each month for your 15% discount.
    If you select the 20% VAR Discount option (above) we need to keep your credit card information on file, so we can automatically charge your account each month.

    Please enter your credit card information below. Thank you.

    Credit Card Type
    Name, exactly as it appears on card

    Card Number
    Expiration Date
     
    Copyright© 2001-2007 Alpha Media, Inc., All Rights Reserved. 
    42 Central Drive, Farmingdale, NY 11735-1202 
    Phone: 631-777-5500, Fax: 631-777-5599