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B2Secure Certified Reseller Application

Thank you for your interest in the B2Secure Reseller Program. This application is for initial qualification purposes only and does not ensure or guarantee that you will be accepted as an authorized reseller.

This information will be reviewed and we will contact you to proceed if warranted. Please complete the information below and click Submit. Incomplete forms will not be processed.

Name:
 Company:
   

Street:
 City:
 State:
 Zip Code:
       

Phone Number:
 Fax Number:
   

E-mail address:
 Company Website:
   

Company Structure:
 Corporation   Partnership   Sole Proprietorship
Date Established:
  
Number of Employees:
  
Type of Business:
  
Target Industries:
  
Do you currently represent or resell any other HR software products:
 Yes   No
If yes, please list product names:

"By clicking the "Submit" button below I attest to the accuracy of the informaton being submitted."


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