Cartesian Reseller Order Form

Please fill out and fax or mail this order form to

Cartesian Products, Inc.
Reseller Sales
34 Hyde Ave, Suite 3
Newton, MA 02458
tel and fax: (617) 249-0185

Your credit card will be charged for the reseller cost and any annual minimums as required, and the purchased materials and end-user license agreement will be mailed to your customer at the email address provided below.

Reseller Information

Reseller name:	____________________________________
Company name:	____________________________________

Customer Information

Company name:	____________________________________
Name of contact person:	____________________________________
Contact's company address:	____________________________________
City:	____________________________________
State:	____________________________________
Zip/postal code:	____________________________________
Country:	____________________________________
Contact's telephone number:	____________________________________
Contact's fax number:	____________________________________
Contact's email address:	____________________________________

Product information

Check the product being purchased and enter associated information.

[ ]	CPC View volume license
	number of seats: ______________________
	Option (check exactly one):
	[ ] create new prepaid account [ ] add to existing account ID: ______________________ [ ] CPC View self-registering installation program [ ] CPC View ax self-registering control [ ] self-registering package (CPC View and CPC View ax) [ ] use previously purchased self-registering installation program or control (must have been purchased by the same customer)
[ ]	CPC conversion battery - per page
	number of pages: ______________________
	battery ID: ___________________________
[ ]	CPC conversion battery - per server
	number of servers: ______________________
	battery IDs: ___________________________
	____________________________________

Reseller cost

See reseller price guide.

Reseller cost (US$):

____________________________________

Payment information

Check here ___ to use the payment information recorded with your reseller registration, or fill out the information below to use an alternative payment method for this order only:

Cardholder name:	____________________________________
Card number:	____________________________________
Expiration date:	____________________________________

Order authorization

By signature below, I authorize Cartesian Products to charge my reseller account the reseller cost of this order as well as any applicable annual minimum charges.

__________________________________

Signature of Reseller

Cartesian Products, Inc.
cpi@cartesianinc.com