Reseller Application

Please fill out the required information below and someone will get back to you shortly.

Name * First Last
Title *
Company *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Ext
Fax - (###) - ### ####
Email *
Type of Partner *
Number of Customers *
Target Industries * Education Financial Government - Federal Government - State/Local Healthcare Manufacturing Pharmaceutical Services Technology Other
How did you hear about our Vendor Partner? *
What do you resell? *
Do you offer Tier 1 Support? * Yes No
Coverage - Regions *
Annual Revenue? *
% of Revenue from Product Sales? *
Number of Employees? *
Which of These Products Have You Tried?
Safend Auditor Protector
Akonix A6000 A1000 L7 Remote Security Agent L7 Skype Manager L7 Builder
Palisade Systems PacketSure ScreenDoor
Privacyware ThreatSentry privatefirewall ASP Pro
ioimage TRK-xxx TRK-MON
Alertlogic Invision Threat Manager Appliance Threat Manager and ActiveWatch
Please tell us a little more about your team...
Number of INSIDE Sales Reps? *
Number of OUTSIDE Sales Reps? *
PRE-sales Engineers? *
POST-sales Engineers? *
Marketing Staff? *
Partner Program Affiliations
Akonix *
CheckPoint *
Cisco *
Computer Associates *
ioimage *
McAfee *
Microsoft *
MX Logic *
SonicWall *
Symantec *
Trend Micro *
WatchGuard *