Centova Technologies Inc.

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Centova Technologies

Reseller Application

Please fill out the following form to apply for a reseller account with Centova Technologies.
Please note that except where otherwise noted, all fields are required and must be completed accurately. Your application will be reviewed by hand by our staff and you will be contacted as soon as possible if your application is approved.
First name:
Last name:
Company name:
E-mail address:
Telephone number:
Company mailing address:
Address (continued):
If this is a registered/licensed business, please enter your business registration number (for our records only):
URL of web site on which Centova Technologies products will be resold:
Type of business:
Expected monthly sales volume:
Do you or your company have prior reselling experience?:
If so, for which products:
Other comments or information that may be relevant to your application (optional):
By submitting this application form you hereby acknowledge that you have read and agree to be bound by the terms of the Centova Technologies Reseller Agreement.
Please enter the word AGREE below to indicate your acceptance of this agreement: