Partner Application

Partner Application Program

Please complete all the fields with as much information as you can provide.

The fields marked with asterisks (*) are required.

Partner Category

Type *

Select One Premier Reseller

Company Information

Company Name *
Address 1 *
Address 2
City *
State *	Select One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming - - Alberta British Columbia Labrador Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Zip/Postal Code *
Country *	Select One - - United States Canada
Phone *
FAX
Website URL *

Your Contact Information

Please supply your contact information so that we may contact you.

Firstname *
Lastname *
Title *
Phone *
Email *
FAX
Contact Type *	SalesMarketingTechnicalOther

Application

Reseller Permit# *
Tax ID# *
Company President *
Date your company was established *
Total number of employees *
Total number of Service Consultants/Field Engineers *
Total number of Inside Sales Reps *
Total number of Outside Sales Reps *
In what geographical area(s) do you have an established on-site sales and technical presence? *
How did you hear about WildPackets? *
Please provide a brief overview of your company, industry focus, and the products and services you provide, including any technology or solution specialization *
Please provide a summary of your company's experience marketing network management solutions *
Describe your customer base (industry, size, platform) *
Please list the names of other vendors' reseller and certification programs in which you participate *
List services your company plans to offer that will incorporate the use of WildPackets products *
What are your company's key differentiators? *