Potential Partner Signup Form

Company *

First Name *

Last Name *

Title

State --Select-- Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Saskatchewan Quebec Non-USA or Canada *

Phone

Email address *

Web address *

Number of employees --Select-- 1-99 100-250 251-499 500-1000 1000+

Year Founded --Select-- 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual Company Revenue --Select-- Up to $250,000 $250,000 - $500,000 $500,000 - $1,000,000 $1,000,000 - $5,000,000 $5,000,000 - $10,000,000 $10,000,000 - $25,000,000 $25,000,000 and Up

Core Business Activity --Select-- Distributor Value Added Reseller (VAR) Retail Distributor Hardware Manufacturer / Assembler Application Service Provider (ASP) System Builder IT Consultancy Other

Other Accredited Vendors --Select-- Microsoft Lotus Novell Checkpoint Cisco Sun SUSE Intel Other

Current Antivirus Software --Select-- none McAfee Symantec-Norton Trend Micro Panda Software Sophos Grisoft Eset Computer Associates Other *

Comments/Questions: