ActiveState - Reseller Partner Program Application

Company name *

Address *

City *

Zip/Postal Code

State/Province

Website URL

Name (First & Last) *

Job Title

Phone Number

Fax

Email *

Company Info

Years in Business

Business Type

Corporation

Partnership

Proprietor

Total # of Employees

# of Sales Staff

# of Inside Sales Staff

# of Outside Sales Staff

Indicate which types of marketing activities you engage in. Check all that apply

Trade Shows

Email Campaigns

Seminars

Print Ads

Other:

Which geographical areas do you serve?

Regional

National

International

How would you classify your company? Check all that apply

Reseller

VAR

Distributor

Training

Which distributors do you purchase from?

Which industries/sectors do you target or specialize in? Check all that apply

Fortune 500

Government

Education

Financial/Banking

High Tech

Development

Training

Health Care

Other:

Please provide a description of your primary value added services.

(integration, training, custom development, etc.)

Are you currently selling development solutions

Yes

If yes, which solutions do you currently sell?

Do you currently have a sales opportunity for our products?

If you wish to submit a purchase order with this application, please email resellers@activestate.com