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Reseller Partner Application

Please fill in the following form to apply for a Reseller/ Credit account.

Disclaimer: Completion of this Reseller/ Credit Account Application does not guarantee that Becrypt will extent a Credit account to the Customer.

Information contained within the form will be used by Becrypt to assess the Customer's suitability for an account. Becrypt reserve the right to refuse a credit account to any customer at Becrypt's own discretion.

If successful in your application, by submitting this form you are agreeing to Becrypt's payment terms and conditions, which are strictly 30 days from date of invoice - this cannot be superseded by the terms on your purchase order. The terms also state that the customer must provide Becrypt with an email address for invoice delivery. Becrypt sends all invoices electronically to all customers in PDF format.

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Applicant's Details

Title*

First Name*

Last Name*

Job Title*

Email*

Company Details

Company Name*

Company Registration No*

VAT Registration No

Total Number of Employees

Total Number of Internal Sales People

Total Number of Field Sales People

Credit Limit Required

Business:

Currency

Primary business activity

Approx annual software spend

Annual Spend on non-mainstream software

Spend Currency

Trading Address

Street Address*

Town/City*

County/State*

Country*

Postcode*

Telephone*

Registered Address (if different from Trading)

Street Address

Town/City

County/State

Country

Postcode

Telephone

Accounts Contact

Title*

First Name*

Last Name*

Job Title*

Email*

Email for Invoices and Statements

Accounts Address (if different from Trading)

Street Address

Town/City

County/State

Country

Postcode

Telephone

Bankers Reference

Bank Name

Sort Code

Account No

Account Name

Street Address

Town/City

County/State

Country

Postcode

By ticking this box, I confirm that I have read and agree to the Becrypt Reseller Terms & Conditions

Have a question? Get in contact


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Email address*

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