PartnerPersona Application

Thank you for your interest in our PartnerPersona Program. Please complete the following fields to begin the process.

* indicates fields required to process this form; all applicable fields are required for approval

Headquarters

Company Name* (no acronyms or abbreviations)

Address*

City*

  

Zip*

Country

  

State*

Main Phone

Main Fax

Toll Free Phone

Web Address*

Your Information
Salutation:
 First Name*
 Last Name*
 Title*

Phone*

Mobile Phone*

Email*

General Company Information
Number of Employees*
 Type of Partner*
Annual Revenue*
$ 		  
Region or territory where you wish to resell

Customer Industries (specify the percentage of business that comes from the following industries)
Health Care % Finance %
Government % Retail %
Primary Product Interest

What security and other product lines do you sell?* (up to 40 characters)

How do you purchase these products today?*

Your technical certificates and capabilites? (up to 40 characters)

Amount of units you feel you can sell during a 12-month period?