NeoCertified Partner Application

Required Information * Company Information Company Name:* Address 1: * Address 2: City:* State/Province:* Zip/Postal Code:* Country:* Telephone Number:* Fax Number: Web Url:* Contact Information First Name:* Last Name:* Title:* Telephone:* Fax: E-mail Address:* Company Description Year Company Established:* Number of Offices and city/state locations:* Number of Full-Time Employees:* Number of Sales People:*   Annual Revenue for: 2000* 2001* 2002*   Business Focus Type of Business:* Select One VAR Security Specialist Consulting System Integrator Other If other please describe: What geographic territory do you serve?* Vertical Market Focus ( if any ):* Select One Financial Insurance Legal Healthcare State/Local Government Federal Government Education Manufacturing Transportation Telecom Service Other What is the size of your typical client:* Select One Small ( less than 100 employees ) Medium ( between 100-1000 employees ) Large ( between 1000-5000 employees ) Very Large ( more than 5000 employees ) What type of products do you currently resell:* Name of Person Submitting this Application:* How did you hear about NeoCertified?* Select One NeoCertified Sales Person NeoCertified Web Site Trade Show / Event Trade Press Article Colleague Other