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.