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Utimaco Safeware Inc. Americas Partner Application Form

Thank you for taking the first step in becoming a member of the Utimaco Solutions Program. Upon reviewing the completed form, Utimaco will contact you to discuss our program and determine the appropriate tier and plan for our companies..

Partner Type

I am interested in:

 Utimaco Sales Partner Program
Utimaco Technology Partner Program
Part A: Contact Information
First Name
Last Name
Email
Company Name
Address
City, State, Zip ,
Country
Phone
Fax
Internet URL

Sales/Marketing Contact
First Name
Last Name
Email
Click here if address is the same as company address above
Address
City, State, Zip ,
Country
Phone
Fax

Technical Contact
First Name
Last Name
Email
Click here if address is the same as company address above
Address
City, State, Zip ,
Country
Phone
Fax
Part B: Company Information
Company Type
public private corporation
partnership proprietorship other
Business Type
consultant reseller developer
systems integrator trainer other
Gross Sales
under $1 million $1-$5 million $6-$10 million
$11-$20 million $21-$40 million Over $40 million
Tax Identification Number
License to Service Revenue ratio
Years in business
Affiliated Organizations
Company Mission Statement
Number of full-time employees
Telesales Consultants Direct Sales
Developers Tech Support DBA
Training Instructors Certified Security (CPI) Total
What partner programs are you currently an active Member, what level, for how long?
Do you use electronic marketing (i.e.: Internet)? If so, please describe:
What expectations do you have of your partnership with Utimaco?
Part C: Product Information
Please list core product offerings by your firm:
Please list the products, if any, you provide post-sales technical support:
Please list the technical certifications held by your staff:
What services do you currently provide?
Describe your product or service target market and sales strategy.
Who are your competitors?

Customer References
1. Company Name
 Contact
 Phone
Type Product/Service Offered
 Date Delivered
2. Company Name
 Contact
 Phone
Type Product/Service Offered
 Date Delivered
3. Company Name
 Contact
 Phone
Type Product/Service Offered
 Date Delivered
Part D: Other Information
How do you sell in North America?
Direct Sales # sales people # office locations
Other
In which geographical area(s) of North America do you resell product?
Northeast Southeast Midwest
Southwest Pacific Northwest West
Canada Mexico All of North America
Describe your support and marketing plans:
How were you referred?
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