FairWarning®

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Partner Application

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

* ALL fields are required
1) Company Name and Address (legal)
Company Name:
Address:
City:
Country:
State or Province:
Zip/Postal Code:

2) Person Completing Application
Name:
Title:
Phone Number:
Email Address:

3) Company Contact Information - Reseller
Name:
Title:
Address:
City:
Country:
State or Province:
Zip/Postal Code:
Phone Number:
Email Address:

4) Technical/Development Contact
Name:
Title:
Address:
City:
Country:
State or Province:
Zip/Postal Code:
Phone Number:
Email Address:

5) Company Background
Website:
Year Company was founded:
Number of Employees:
Public Private
Profile describing your company: (100 words or less)
Brief history:
Primary businesses (100 words or less)
Product(s) you currently market that may be complimentary to FairWarning® & short description of the benefits of this bundling:

6) Please list other security products you currently market
Vendor/Product Name 1:
Vendor/Product Name 2:
Vendor/Product Name 3:
Vendor/Product Name 4:
Vendor/Product Name 5:
Vendor/Product Name 6:
Vendor/Product Name 7:
Others:

7) Sales and Partnerships
Total revenue of your company during the last three years, per annum, US$:
Annual software applications sales revenue US$:
% of above in healthcare:
% of above in federal:
Who are your primary customers?
Major ISV's represented:
Major Technology Partners:
Which (if any) Distributors do you work with? I.E. Avnet, Arrow, Etc.
Do you currently provide customer support for other ISV's?
Are you interested in providing customer and/or technical support to FairWarning® customers?	Customer Support Technical Support

8) Markets
Primary market geographies:	Americas - States (or Regions) covered: International:
Size, by bed size, of health systems that your company primarily target: (select all that apply)	less than 500 500-1000 1000-2500 2500+
Your products and services primarily target which industries: (select all that apply):	Financial Services Healthcare Manufacturing Retail Education Services Utilities Transportation Government Others Communications, Media, & Entertainment

9) Please also provide a logo with this application in jpg or tif format. (Optional)


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