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Point of contact for Partner Program
Company Name Website
Contact Name Email
Job Title Telephone
Job Function Mobile
Address Information
Address Zip/Postal Code
Telephone
Fax
City Mobile
Billing Information
Contact Name Job Title
Address
Zip/Post code
Telephone
CityEmail
Additional Contacts
Full Name e-mail Phone
CEO/MD
Primary Sales
Primary Technical
Primary Marketing
Other
Partner Application
CRYPTOCard340 March RoadSuite 600Ottawa, OntarioK2K 2E4 Canada
Toll Free: 800-307-7042Fax: [email protected]
State/Province
State/Province
Sources of Revenue
Software % Service %
Hardware % Product %
Security Products Network Infrastructure
Business Information
Registered No. Year established
No. of OfficesProject Revenue (2007)
Reported Annual Revenue 2006 2005 2004
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ProductsPlease indicate which of the following products you provide:
Cisco ASA WatchGuard Firebox
Other
Juniper SSG/ Netscreen range Sonic Wall
Imprivata SSO
Check Point VPN
How many sales per week? How many sales per month?
Average revenue from each deal?
What is the % of the proposal price that is for professional services?
Average deal size in users?
Remote Access Products
Evidian
Symantec Kaspersky
Other
McAfee Fortinet
Check Point
Barracuda
BitDefender
Security Products
Which areas will be your primary focus with CRYPTOCard?
CRYPTO-Shield "Windows" CRYPTO-Shield "Apple" Hardware Tokens
CRYPTO-Shield "Linux" CRYPTO-MAS Software Tokens
Vertical Market Focus (select all that apply)
Manufacturing Technology Retail
Finance Healthcare Local Government
Pharmaceutical Other
Staffing Information
Type of employee Number
Post-Sales Technical
Field Sales
Marketing Internal
Sales
Trainer
Pre-Sales Technical
If you have a training centre, what is your class capacity?
Primary Distributor:
Additional Distributors:
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Marketing Events / Lead Generation
Seminars Trade Shows Webinars
Telemarketing Direct Mail Referrals
Email Blast Media Advertising
Other
Number of Marketing events: Month Quarter
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Partner Acceptance
I confirm that all information provided is true and give permission for CRYPTOCard to use the information provided for CRYPTOCard's owninternal use. I am a company Director or an Authorised signatory.
Signature DateName
Credit Information
Please complete the section below if you wish to request credit terms with CRYPTOCard. Any additional supporting document, ex: auditreports, can be included with the application.
Bank Name:
Bank Address:
Account #: Contact Person:
Services Offered (Select all that apply)
Managed Service Security Policy Development IPT
Professional Services Vulnerability Assessments Voice/Data
Installation & Configuration Remote Working Solutions WLAN Design
Information Security Web Applications Network Design
Other
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