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:
Who is your Internet Service Provider?
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:
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
If yes: Please specify company and program name: