Proxix Business Partner Program Application

Thank you for your interest in Proxix's Business Partner Program. Please complete the application below. All information provided will be kept confidential. Once you have submitted the application, a Proxix representative will contact you.

Please fill in all fields

Company Name:
Applicant First Name:
Applicant Last Name:
Title:
Address:	(If your company has more than one office, please provide the address of the office from which this inquiry originates.)
City:
State:
Province:
ZIP or Postal Code:
Country:
Telephone:
Fax:
Company Web Site:
Email:
Partner Choice:
Partner Level:
Do you currently have a MDA/NDA with Proxix? Yes No If "yes," please specify:

Please answer all questions.

Please provide us with a general overview of your current business. Feel free to mail company profiles, product brochures, or any other descriptive information that you would like to share with us.

In what year was your company established?

Number of employees:

What is your primary vertical market and/or technology focus?

What geographical areas does your company cover?

How many professional sales staff do you have dedicated to your sales efforts?

What Proxix technology are you interested in reselling?

What value-added services do you provide? (Data, training, hardware, etc.)

Describe your typical sales and marketing scenario.

sPlease provide information on your company's experience with Proxix products.

For more information regarding Proxix's Partner Program contact:
Bob Brick
Tel: 727.781.2662, ext. 304
Email: bbrick@proxix.com