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Reseller Product Questionnaire

If you are here, you have probably read our dealer newsletter and are interested in having us send some business your way! Please fill out the questionnaire completely. If we feel there is a good match between your application and our hardware products, we will refer customers to you as well as provide a link and information on our website. Thank you for your input!

*in order to refer business to you, these fields on this form must be completed.]

Would you like us to link to your website? yes no  
Would you like us to link to your product page? yes no  

Company Name: *
Contact Name: *
Address: *
City: *
State: *
Zip: *
Phone: *
Fax: *
Email address: *

Area of Coverage: *

Do you have dealers nationwide? yes no  

Please give a brief description of your application:*
What is the price range of your application? *

What year was your application introduced: *
What are your target industries?:
*check all that apply
Retail
Manufacturing
 
Warehousing/Distribution
 
Other

What platform(s) does
your application run on? 		Windows Dos  
*check all that apply Linux Unix  
  Mac OS Other
           
What language is your
application written in? 		VB Access  
*check all that apply Delphi C++  
      Other
           
Is source code available? yes no  
           
Does it have an OBDC
interface? 		yes no  
           
Is a demo available? yes no  
           
Which of our products do you include or recommend with your application? *

WDP

WDR
TriCoder  RF Terminal
Magstripe RF Scanners
           
Do you carry bar code products from other vendors? * yes* no  

* If yes, list products:
   
What is your website address?:
URL of your product page:

Do you list Worth Data Products on your website? yes* no  
* If yes, URL of page where Worth Data products are listed: