Solacom Parnters

Channel Partner Application

Note: Fields marked with an asterik (*) indicate required information.

1. Company Information
* Company Name:
* Address:
* City:
* State/Province:
* Zip/Postal Code:
* Country:
* Phone:
* Fax:
* Web site address:
2. Company Contact
* First Name:
* Last Name:
* Title:
* Phone:
* E-mail:
* Fax:
3. Business Information
* Number of years company has been in business:
* What is the company's industy/market focus for security products?
     
* What geographic areas does company sell and service?
United States:        
International:          
* What is your business type?






What overall percentage of your business is:
% Defense % Federal Government
% State and Local Government % Commercial
What is the company's total annual revenue for the last two years (US Dollars)?
Last year: $   Two years ago: $
* Which of the following Solacom products and solutions is your company interested in (check all that apply)?




* What other vendors does your company currently partner with? Please list.
4. Additional Contact Information
Primary Sales Contact
Name:
Phone:  Ext:
E-mail:
Fax:
Primary Technical Contact
Name:
Phone:  Ext:
E-mail:
Fax:
Primary Marketing Contact
Name:
Phone:  Ext:
E-mail:
Fax:
5. References
Please list one current customer reference.
Company Name:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Company Contact:
Phone:
E-mail:
Fax: