AppEazy Change of Reseller Request

Before Applianz can change your reseller on record you must complete the following form.  

System Administrator *
System Administrator
Phone
Phone
Requested Change Date
Requested Change Date
Current Account Representative
Current Account Representative
Is the reseller aware of your request?
May we inform the reseller of your wishes if they do not already know?
Address
Address
New Account Representative
New Account Representative
Phone
Phone
Access to your AppEazy System? *
Would you like us to create a new user account on your AppEazy system under the new Resellers name?
Change Confirmation
For the safety of your company and its data we will verify this information before giving any new parties access to your AppEazy system. Please confirm below that you understand the risks and want to proceed with changing your reseller.
Confirmation *