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Distributor Request Form

Fill in the form below to let us know about your company and your business in the web in the framework of future partnership with ActualScripts, Company. Before submitting, be sure to read all terms of our Distributor License.

If you have any problems with the form below, please contact us for assistance.

Contact Information

The Contact Information submitted below is for our use only. We will never share this information with any third parties.

* — required fields

* First and Last Name:
Company:
* Street Address:
* City:
* State/Province:
* Country:
* Zip/Postal Code:
* E-mail:
Fax:
* Phone:

Business Information

* Web Site URL:
	Address of the site where you will be distributing the software. A valid, working address is required. No IP addresses. For example: http://www.domain.com

To register sales and have actual information about revenue received, you will need a username and password for access to the partner area. Please enter your choices for a username and password below. Your username and password may contain letters and numbers only and must be between 3 and 8 characters.

* Username:
* Password:

License Agreement

I have read, understand, and agree to all terms of the Distributor License.

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