IMiN Presence Partner Program Reseller Application
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Company Information:
Company Name:
Street Address:
City:  State:  Zip:
Shipping Address
(if different):
City:  State:  Zip:
Primary Phone:
Alternate Phone 
(if applicable):
Fax Number:
URL:
Years in Business:
Primary Business Management Contact:
First Name: Last Name:
Phone: Email:
Application/Administrative Contact:
First Name: Last Name:
Phone: Email:
Sales Contact:
First Name: Last Name:
Phone: Email:
Technical Contact:
First Name: Last Name:
Phone: Email:

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If you prefer to fill out an application and mail or fax it in, you may download the application form here. Please send it to:

IMiN Presence Partner Program
23844 Hawthorne Blvd. , Suite 101
Torrance, CA 90505
Fax: 310.303.3325

We will process your application immediately upon receipt.

If you have any questions regarding the IMiN Presence Partner Program, IMiN, or R. B. Zack & Associates, Inc. products, please contact Tim Martin at 310.303.3320 ext 126 or email partners@ebs-imin.com.
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