Industry Resellers Enquiry Form

Thank you for your interest in becoming a TOPAZ Premium VAR, we would like to invite you to complete the application form & one of our team will be in touch to discuss further with you.

If approved you will be sent log in details for our partner site & become eligible for all partner benefits.

TOPAZ Digital will keep all information submitted confidential. Please read our privacy statement for more details.

Business Information

Company *

Address *


State / Province


Postal Code / Zip



Company Contact


First Name *

Last Name

Your Title

Phone No.

Email *

About Your Business

Company Type

Years in Business

Sales Geography Description

Primary Market

Describe your Primary Markets

Primary Distributor

About Your Products

What value-added services you provide? *

Other Services

What type of solution(s) do you provide? *

Other Solutions

About Your Employees

Total no. of Employees

How many Field Sales Representatives?

How many Inside Sales Representative?

TOPAZ Digital will keep you informed of products, services & promotions from time to time, we will never share your data with any other organization. If you would prefer not to receive updates from TOPAZ please uncheck the box.


I agree the information supplied on the above form is accurate to the best of my knowledge.*

If you have any questions or require any help completing the application form please contact us at