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Partnership Application

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Partnership Application 

All fields are required. Incomplete applications will not be 
considered. If the information requested is not applicable, 
put N/A in the field.

Company Name:
Headquarters Address:
Phone: 
Website:  
Submitted By:

Primary Contact Information
Sales Contact:
Name:
Title:
Email:
Phone:

Technical Contact (Pre-Sales):
Name: 
Title:
Email:
Phone:

Marketing Contact:
Name:
Title:
Email:
Phone:

Purchasing/Pricing Contact:
Name:
Title:
Email: 
Phone:

Service/Support Contact (Post-Sales):
Name:   
Title:
Email:
Phone:

Business Information
Revenue Breakdown % Hardware
% Software
% Service

Business Focus  % Commercial
% Government

Vertical Market Focus % Finance
% Healthcare
% Manufacturing
% Telecommunications
% Education
% Government
% Transportation
% Media/Entertainment
% Others

Does your company focus on selling locally, regionally or nationally?
Please list the areas covered.

Product Interested
AT.Pass Hermes 2 SAMS

Form of Partnership
Reseller OEM Partner ASP Partner

 



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