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Visual Paradigm Reseller Application Form Participation in the Visual Paradigm Reseller Partner Program is not automatic. Upon completion of this application we will contact you to follow up on your request. Required fields are indicated by * Company Address Company Name* Postal Address* City* State/Province Country* Postal Code* Please Select Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Terr. Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo (formerly Zaire) Cook Islands Costa Rica Cote d\Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Terr. Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See (Vatican City) Honduras Hong Kong Hungary Iceland India Indonesia Ireland Iran Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea South Kuwait Kyrgyzstan Lao People"s Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papau New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa (Western) San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia Spain Sri Lanka Suriname Svalbard Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay USA Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Web Site* Contact Title First Name* Last Name* Email* Phone Fax General Business Information Total Number of Employees* Number of Dedicated Inside Sales Staff* Number of Dedicated Outside Sales Staff* Number of Dedicated Marketing Staff* What Region do you Cover? Years in Business 0 - 5 months 6 - 11 months 1 - 2 years 2 - 5 years 5+ years Which best describes your Gross Revenue (in US $)? (This Information is Confidential and is used for Evaluation Purposes only.) <1 million 1 - 5 million 6 - 10 million 11 - 50 million 51 - 100 million 100+ million How much of your Revenue (in US $) comes from Visual Paradigm related products? <25K 25 - 50K 50 - 75K 100+ K What other Companies do you have Reseller Agreements with?

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