Socket Reseller Application

Thank you for your interest in Socket's Reseller Program! Please fill out the application below and our reseller coordinator will follow up with you in the next two business days.

If you have any questions about the program, please call 1-800-762-5383 ext. 182.

First Name:
Last Name:
Business Name:
Address:
City
State:
ZIP:
E-mail Address:
Phone Number:

My business specializes in (check all that apply):	Computer Sales
	Computer Repair
	Electronics
	Other

What type of customers does your business serve?	Mostly residential
	Mostly business
	An even mix of residential and business

Do you have a storefront?	Yes
	No

How did you hear about Socket's Reseller Program?

Comments & Additional Questions: