Value Added Reseller (VAR)

Want to become a Value Added Reseller (VAR) of DirectorMD?
Please Complete following VAR information request.

First Name*

Last Name*

Organization*

Address*

City*

State*

Zip*

Telephone*

Fax

Email*

Who are your current customers?

Solo physicians

Physician practices (Less than 25 physicians)

Physician practices (25-50 physicians)

Physician practices (50-100 physicians)

Physician practices (More than 100 physicians)

Hospitals (Less than 50 beds)

Hospitals (50-100 beds)

Hospitals (More than 100 beds)

Any Specialties, which you are
more familiar selling to?

What all you have been selling
to physician community?
(Please Specify)

What is average annual sales volume of your last 3 years
sales to physicians?

How many sales people have
you been employing?

How many technical support
people have you been employing?

What geographic are as are
your strong-holds?

How did you hear about
DirectorMD?

Any other comments

( * indicates mandatory fields )

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