Become A Partner
General Information
Required fields are labelled in red.
How did you hear about the referral program?
I am interested in becoming a:
Referral Partner
Reseller Partner
Company Name:
Address:
City:
State:
Zip:
Phone:
Mobile:
Fax:
URL:
Who is your Internet Service Provider?
Connection:
— select —
Dial-Up
DSL
T1
Other
Business Information
Primary Contact:
Title
Phone:
E-mail:
Secondary Contact:
Title:
Phone:
E-mail:
Year Company Founded:
# Employees:
# Sales:
# Technicians:
Gross Annual Revenue Last Year:
Projected Gross Annual Revenue This Year:
Revenue Breakdown:
Hardware:
%
Service/Support
%
Software:
%
Training:
%
Other:
%
Specify:
Average Transaction Size: $
One-time
Monthly
Yearly
Small-Med Business:
%
Corporate
%
Government:
%
Education:
%
Retail:
%
Other:
%
Specify:
Average number of new customers added each month:
Number of Customers:
select
1-24
25-49
50-99
100-299
300+
Business Model
* Which description best characterizes your business?
Systems Integrator
Web Developer
Voice/Long Distance Reseller
Marketing Agency
ISP
Value-Added Reseller
ASP
CLEC
Systems / Software Sales
Other (specify):
What geographic territory does your company market and share?
Target Market(s) (check all that apply):
Consumer
SOHO
Voice/Long Distance Reseller
Fortune 500
Large
Mid
Internet Experience
* Has your company ever sold Internet products and/or services?
If yes: What types of services have most of your customers purchased?
Dial-Up
Co-Location
Shared Web Hosting
DSL
Frame/T1/DS-3
Dedicated Servers
OC-x
Managed Services
Virtual Private Servers
Other (specify):
What is your estimated annual revenue from Internet products and/or services?
$
Is your company currently participating in any Internet Partner Programs?
Yes
No
If yes: Please specify company and program name:
