Reseller NFR Copy Order Form

Reseller Not For Resale (NFR) Order Form

To get your free NFR software, please complete the following:

1. Please PRINT out this form on your company's letterhead (or include a business card) and fax or mail it to:

Attn: Randy Figueroa

DataViz. Inc.

Merritt Corporate Woods

612 Wheelers Farms Road

Milford, CT 06461

203-874-4345(fax)

2. Attach any proof of employment. Proof of employment may include company letterhead, business card, pay stub, etc.

Please check the box next to the product you wish to order. Limit, one copy of each SKU per reseller location.

Handheld/Smartphone Solutions

	Documents To Go for Palm OS (Windows Desktop)
	Documents To Go for Palm OS (Mac Desktop)
	Documents To Go for Windows Mobile
	Documents To Go for Symbian UIQ
	Documents To Go for Symbian Series 80
	RoadSync for Palm OS
	RoadSync for Windows Mobile 2003
	RoadSync for Symbian UIQ 3/3.1
	RoadSync for Symbian S60
	RoadSync for Symbian Series 80
	RoadSync for Java MIDP 2.0
	Beyond Contact for Palm OS
	SmartList To Go for Palm OS

Windows Solutions

	Conversions Plus
	Passwords Plus

Macintosh Solutions

	MacLinkPlus Deluxe
	Passwords Plus

1. Your company's primary business function: (check one)

Computer Products Reseller (e.g. Retail Store)

Computer Solutions Provider (e.g. Consultant, VAR, SI)

Other: (please list)

2. Please list all the DataViz products (if any) your company stocks:

Please provide any Comments, feedback or requests below:

Full Name:

Reseller Company Name:

Reseller ID Number or
Distributor Account Number:

Reseller Address:

CDs must be shipped to reseller address

City:

State:

Zip (Postal Code:)

Country (if outside of the USA):

Phone Number:

E-Mail Address:

Fax Number:

Credit Card Type:

American Express VISA MasterCard

Credit Card Number:
CD orders only

Expiration Date:

Electronic download orders will be emailed to you at no charge upon completion of order entry.
For CD orders shipped in the US, your credit card will be charged $9.99 for shipping and handling charges (for single item orders and $11.99 for two or more products).
For shipments made to Canada, your credit card will be charged $20.00 for shipping and handling charges (for single item orders and $25.00 for two or more products).
For shipments made to resellers located outside of the U.S. and/or Canada, your credit card will be charged $25.00 for shipping and handling charges (for single item orders and $30.00 for two or more products).
Shipping Time: your order may not get processed on the same day you place it. As soon as the order is placed in our system, it will generally take 3-5 business days to get to you.

Full Name:
Reseller Company Name:
Reseller ID Number or Distributor Account Number:
Reseller Address:		CDs must be shipped to reseller address
City:
State:
Zip (Postal Code:)
Country (if outside of the USA):
Phone Number:
E-Mail Address:
Fax Number:
Credit Card Type:	American Express VISA MasterCard
Credit Card Number:		CD orders only
Expiration Date: