Business Partner Information Form

Partner Registration:

Thank you for your interest in becoming a Synetcom Channel Partner. Please complete the following form to be considered as an authorized partner. Please note that this is not a contract but rather an information form used to evaluate the potential of our business relationship. We assure you that all information will be kept in strict confidentiality. Our team will review your application and respond back to you with our decision.

    PRIMARY PARTNER CONTACT INFORMATION

    *First Name:

    *Last Name:

    *Email

    *Title:

    *Phone:

    Fax:

    COMPANY PROFILE

    Company Name:

    Partner Type:

    Address:

    Country:

    Telephone No.:

    Fax No.:

    Website:

    Date of Incorporation:

    BIR Registration #:

    Years in Business:

    No. of Employees:

    Principal Products:

    Paid Up Capital:

    Authorized Capital:

    Name of Shareholders:






    Percentage:






    Company Personnel:
    1-5051-99100-499500-9991000+

    Sales Inside %:

    Sales Outside %:

    Technical %:

    Annual Revenue:
    0-25 Million25-50 Million51-100 Million101-500 Million>501 Million

    Hardware %:

    Software %:

    Service %:

    Top 5 Clients:

    Account Name:





    Size of Project:





    Inclusive Date:





    Market Segment: *
    SMB
    Enterprise
    Global Enterprise
    Service Provider
    Other

    Vertical Markets: *
    Financial
    Healthcare
    Industrial Retail
    Telecommunications
    Education
    Government
    Technology
    Broadcast Media
    Others

    Networking Products Sold: *
    Arista
    Big Switch
    Bluecat
    Cisco
    Extreme
    F5
    HP
    Infoblox
    Juniper
    Riverbed

    Applications Sold: *
    Microsoft
    Oracle
    SAP
    VMware

    Security Products Sold: *
    Arbor Networks
    Bluecoat
    Check Point
    F5
    FireEye
    Fortinet
    McAffee
    Palo Alto Networks
    Symantec
    Tipping Point
    Other

    Storage Products Sold: *
    EMC
    HDS
    NetApp
    Nimble
    Nutanix

    ADC Products Sold: *

    A10
    Barracuda
    Citrix
    F5
    Fortinet
    Radware
    Riverbed

    Wireless Products Sold: *
    Ruckus
    Meru
    Cisco
    Firetide
    Dragonwave

    KEY CONTACT INFORMATION

    President/Director/Chairman/GM
    Name:

    Designation:

    Email:

    Marketing:
    Name:

    Designation:

    Email:

    Technical:
    Name:

    Designation:

    Email:

    Accounting:
    Name:

    Designation:

    Email:

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