Climb Channel Solutions - Reseller Application Form

Customer Info

Financials

Documents

Submit

Application Reference Number: {{model.Id > 0 ? model.Id : '0'}}

Instructions

Thank you for your interest in becoming a Climb Reseller. Please read these instructions carefully as this may help speed up the application process. Before starting the application, please have the following information ready:

Your company's financial information e.g. Tax Id, Date Established etc...
If you are applying for terms, please have your bank account information, bank references and trade references available.
Your reseller certificate.

Once you have started filling out the application, do not refresh the page or hit the back button on your browser.

To start the application process, please answer the following question:

Are you an existing Climb reseller?

Yes No

Customer Information

Company Name

Legal DBA Name

Date of Business Established (mm/dd/yyyy)

Select Country

Address 1

Address 2

City

State/Province

Zip/Postal Code

Phone

Company Website

Dun & Bradstreet #

Annual Revenue

Number of Employees

How did you hear about us?

What product lines brought you to us?

Tax Information

Employer Identification Number (EIN)

GST / HST Number

VAT Number

Contact Information

Main Sales Contact

Name

Job Title

Phone

Main Service Contact

Name

Job Title

Phone

Web Account Contact

The information provided in this section will be utilized for creating the initial account for accessing our Climb Channel Solutions website once this application has been reviewed and approved.

The information provided in this section will be utilized for creating the initial account for accessing our Climb Channel Solutions website. If you elect to register with the Climb Expedition Cloud Marketplace, you will automatically get enrolled for an account once this application has been reviewed and approved.

Name

Job Title

Phone

Financial Information

Main Accounting Contact

Name

Job Title

Phone

Billing Email

Company Type Information

Private or Public?

Payment Type

Name

Job Title

Company Ownership (%)

Company Type

Bank and Trade References Upload

You have selected terms. You can either fill the Banking References below or upload your references. Uploads must be either a PDF, JPEG, JPG, PNG or Zip file and no lorger than 4mb.

Please click browse, select your Banking References, and then click upload.

Bank Reference

Bank Name

Select Country

Address 1

Address 2

City

State/Province

Zip/Postal Code

Account Number

Main Phone

Main Fax

Contact Name

Contact Email

Trade References

Reference 1

Company Name

Country

Address 1

Address 2

City

State/Province

Zip/Postal Code

Phone

Contact Name

Contact Email

Reference 2

Company Name

Country

Address 1

Address 2

City

State/Province

Zip/Postal Code

Phone

Contact Name

Contact Email

Reference 3

Company Name

Country

Address 1

Address 2

City

State/Province

Zip/Postal Code

Phone

Contact Name

Contact Email

Market Information

Market

Markets Served (Select all that apply)

Geographic Reach

Verticals

We focus on the following verticals (Select all that apply)

Reseller Tax Certificate Upload

Important: For USA applicants, please include your Reseller Tax Certificate and/or Sales and US Tax Exempt form at a minimum.

Please use this section to upload your Reseller Certificate. Uploads must be either a PDF, JPEG, JPG, PNG or Zip file and no lorger than 4mb.

Please click browse, select your Reseller Certficate, and then click upload.

Financials Upload

Important: For all Country applicants applying for payment terms, please upload your latest Audited Financials. If this is not available, your most recent Balance Sheet or Income Statement can be provided.

Please use this section to upload your Audited Financials. Uploads must be either a PDF, JPEG, JPG, PNG or Zip file and no lorger than 4mb.

Please click browse, select your Reseller Certficate, and then click upload.

Application Submission

Application Agreement
By agreeing to this reseller application form, you are confirming that you have approval authorization at your company and will be bound by the Climb Channel Solutions Reseller Terms & Conditions, which are available at: Climb Channel Solutions Terms & Conditions. In addition, permission is granted to Climb Channel Solutions, to obtain credit information from all listed trade and bank references. I understand that the credit terms are net 30 days from date of invoice unless otherwise stated, and that the account may be subject to a finance charge on past-due balances of 1.5 % per month (18% per annum). I understand that orders may not be shipped if the account is past due. I certify that all information contained in this credit application is correct in all respects. I also certify that I am an authorized signing official of the Company named above.

I have read and agree to the Terms and Conditions. *

Name

Job Title

Subscription Preference

Thank you for submitting your application to become a Climb Channel Solutions Reseller. Note: Until you are approved for credit, we will process your initial orders on credit card or with pre-payment.

Your application reference number is {{tempAppId}}

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Reseller Application