This is the form for the Elastix Reseller Program Applicants.
Please review the form first and fill it with proper information.
Fields with an asterisk are obligatory.
If you have an error once you fill the form, please review the comment and make the necessary corrections.
First Name (*)
Please type your first name.
Last Name (*)
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Company (*)
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Role
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Phone Number (*)
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Fax Number (*)
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Email (*)
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Web Site
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Address 1 (*)
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Address 2
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City (*)
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State (*)
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Postal Code
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Country (*)
Country Name Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo, Democratic Republic of the (Zaire) Congo, Republic of Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe (French) Guam (USA) Guatemala Guinea Guinea Bissau Guyana Haiti Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast (Cote D`Ivoire) Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique (French) Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia (French) New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Polynesia (French) Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste (East Timor) Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Wallis and Futuna Islands Yemen Zambia Zimbabwe Other Please Select a Country
Reseller Level (*)
Please Select a Level Bronze Reseller Silver Reseller Please select the partnership level that you are interested
Elastix Certification Code
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If you already purchase a Support Pack (5 hour bundle) please write it down
Ticket Number
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Gross Revenue 2011 in US Dollars? (*)
< 5,000 5,000 < 10,000 10,000 < 50,000 50,000 < 100,000 100,000 < 500,000 > 500,000 Invalid Input
Products & Services (*)
Network cabling Project management Onsite support 24x7 support Asterisk training Call termination Provisioning and configuration IP Telephony architecture and consulting Remote support 8x5 support IP cards/phones/accessories
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What certifications do your employees hold? (*)
DCAP ECE ECT RHCE PHP LPI RHCT CCNA OTHER
Please Select a Item
Number of Employees (*)
Please Select a Range 1-20 21-50 51-100 More than 100 Please tell us how big is your company.
How many Asterisk skilled employees do you have? (*)
Select Employees Number None 1 2 3 4 5-9 10-15 16-25 25+ Please select an option
How many sales people do you employ? (*)
Select Sales Employees Number None 1 2 3 4 5-9 10-15 16-25 25+ Invalid Input
Physical Locations? (*)
Select Physical Location Number 1 2 3-5 5+ Invalid Input
Do you currently install Elastix? (*)
YES NO
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Which other PBX system (proprietary or Asterisk-based) do you resell? Please specify (*)
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Why do you want to become an Elastix Reseller?
To resell hardware To execute telephony projects To resell Elastix support Suscriptions To conduct training To colaborate with the project To buy Elastix support To perform support
Please tell us the reason to become a partner
If you select other please tell us the reason
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Which of the following services or products do you intend to sell? (*)
Elastix Appliance ELX Series Elastibank Channel Banks Web Chat Technical Support Elastix Trainning Customized Development Implementation Projects Elastix Support Subscriptions Other
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How did you hear about Elastix? (*)
Google Ad Google Search Yahoo MSN Word of Mouth Forum post Elastix.org Other
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What features of Elastix drove your interest? Please specify
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Confirmation Code
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