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Galaxy Partner Application
Galaxy Partner Application
Please check the applicable category for which you are applying.
Legal Company Information:
Company Name
*
Owner name:
*
Contact name:
*
Contact email address
*
Street address
*
City:
*
Prov/State:
*
Country:
*
Postal/ZIP Code:
*
Phone:
Fax:
Technical Knowledge:
How would you rate your capabilities? (On a scale 1-10, 10 being expert. Add comments).
Computer Knowledge (hardware):
Please enter a number from
0
to
10
.
Computer Knowledge (software):
Please enter a number from
0
to
10
.
Networking Hardware & Software:
Please enter a number from
0
to
10
.
Wireless/WISP:
Please enter a number from
0
to
10
.
Satellite Installation:
Please enter a number from
0
to
10
.
VoIP:
Please enter a number from
0
to
10
.
Are you associated with any Galaxy Broadband reseller?
Comments:
Industry Experience:
(To be completed by Installer applicants only.)
Do you currently sell Internet Services (VSAT)?
Yes
No
How many systems have you installed:
Do you have a Certified Installer?
Yes
No
If Yes, how many:
Please enter a number from
0
to
50
.
Do you sell/provide any Managed Services?
Yes
No
Why would you like to become a Galaxy Certified Installer?
I accept the Terms and Conditions
I certify that the above information is correct and I accept the Terms and Conditions of the Galaxy Broadband Dealer Program as outlined.
*
Yes
No
Authorized Representative:
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