FairWarning®

Partner Application

Thanks for your interest in FairWarning®, please fill out the form below and we will be in touch shortly.

Company Name:

Address:

City:

State:

Zip:

Website:

Phone Number:

Public Private

Individual Contact Name:

Contact Phone Number:

Email Address:

Title:

How did you hear about FairWarning and its partner program:

Company Type:

Reseller
VAR
SI

Lines of Business:

Security
Clinical Applications
Storage
Network Services
Hardware

Products Sold:

Symantec
SUN
Oracle
ArcSight
Passlogix
Imprivata
Other:

Revenue:

Percentage of revenue sold in healthcare:

Size of Salesforce:

Number of salesforce dedicated to healthcare:

Applicable strategic partners to FairWarning:

Type of partnership applying for:

Additional information FairWarning should consider in reviewing this application?


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