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.


Are you Human?

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