Thank you for your interest in becoming a Dealer or Affiliate
Please fill out the following to submit your application to become an dealer/affiliate of Ki Systems, Inc.
This information will be kept strictly confidential, and not be used for any third party purpose.
Please fill in all the required information.
First Name:
Last Name:
Company/Institution:
Description of Business:
Position in Company:
Kind of Business:
Email Address:
City:
State/Province:
Telephone (including area code):
Zip Code or Postal Code
Country:
Who referred you, or where did you hear about the Ki Biz System?
Do you do FileMaker custom database development? Yes How long?
Are you a consultant to small businesses? Yes How long?
Do you sell products/services to small business? Yes Please specify:
Are you focused on a vertical market? Yes If, yes please specify
Do you have any questions about Ki Systems or the Affiliate Program?
Yrs in Business:
No. of Employees:
