Reseller Order Form
Name
Reseller ID(Leave blank if you don't have a Reseller ID)
Email (Skip if you have entered your Reseller ID)
Phone(Skip if you have entered your Reseller ID)
Billing Address (Skip if you have entered your Reseller ID)
Country / City (Skip if you have entered your Reseller ID)
Payment Method	Cheque D.D. Cash
What are you Interested in Reselling?	(Select an Option) POP3 E-mail Account POP3 / Telnet / FTP Account Budget Web Account Standard Professional Web Account Super Virtual Server Webmaster Account Internet E-mail Solution Intranet Solutions Bulk Mail Software Other
Account Name / Login Details