Partner Registration

Company Contact Information

Staff Contact Information

Main Contact Name
Main Contact Title	* Please enter the contact title
Main Contact Phone	* Please enter the contact phone
Main Contact Email	* E-mail is not valid format
Sales Contact
Sales Person's Title
Sales Person's Phone
Sales Person's Email
Technical Contact
Technical Person's Title
Techincal Person's Phone
Technical Person's Email	Email is not in valid format
Company Information
Year Business was established * Enter 4-digit year Please enter year
Number of employees  * Please enter number of employee at this location Required number
Total number of systems engineers & consutants * Please enter total number of system engineer Required number
Number of sales people * Please enter number of sales people. Required number
< $500,000 $.5 to 1 Million $1-5 Million $5+ Million   Annual Revenues *
Annual Sales Revenue Sources:
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%   Hardware      0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%   Software      0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%   Services
Type of Business: (Check all that apply)
Value Added Reseller       Systems Integrator      Software Reseller      Distributor      Managed Services      Other
If Distributor:
< 50 50-100 100-200 >200 How many active resellers do you supply to (Active indicates order received from Reseller in the last quarter)
Markets Served:
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%   Government      0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%   Education      0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%   Small to Medium Business      0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%   Enterprise
Active Customers (Active indicates customers who have purchased in the last 24 months)
less than 100 100-500 500-2000 2000-4000 4000+ Number of active customers:
Hardware Products you represent: (Check all that apply)
HP      Dell      IBM      Fujitsu Siemens Computers      Cisco      Other
Software Products you represent: (Check all that apply)
Peregrine      Tivoli      Microsoft SMS      Intel LAN Desk      Computer Associates      Symantec      Network Associates      Citrix Associates      VMware      IBM Software      Other
Certifications: (Check all that apply)
Microsoft MCSE      Novel Certified Engineer      Network Associates TSP       Knowledge of Windows OS Platforms (NT/2000 servers/workstations, 9x)      HP ASE       Knowledge of DHCP requirements & specifications      Knowledge of TCP/IP       Knowledge of NT/2000 server administration       Working knowledge of routers, hubs and switches
Interested In: (Check all that apply)
Client and Mobile Management      Asset and Service Management      Server Management      Security Management      Application Packaging

Thank you, for completing the Partner Registration Form. Your details are now in our database we shall contact you shortly to discuss your requirements.

Kind Regards,
CellTerra Business Development Team