Membership Application

Type of Membership Seeking *
VAR ($250 annually) - Your primary focus is servicing and reselling products developed by othersAffiliate ($250 annually) - Your primary focus is the development of products
Name *

Title *

Email Address *

Business Phone Number *

Business Name *

Billing Address *

Website *

Your Position with Business *
PresidentOwnerPartnerOther
If other, please specify:

Please list three professional references

Reference 1 Name: *

Phone: *

Email: *

Reference 2 Name: *

Phone: *

Email: *

Reference 3 Name: *

Phone: *

Email: *

Business Information

Please complete the below business profile.

Year Established *

Please list your partners or parent organizations: *

Please describe your geographic market: *

Please list any satellite or subsidiary company names and locations: *


Please list the product(s) you represent, including product name and number of installations: *

Please select your primary affiliation with these product(s): *
VARResellerDeveloperOwnerCommission Agent/Direct Sales PersonUser

Business Model

(Check all that apply for each category)

Hardware: *
SellInstallSupportSub-contract with another organizationNot Applicable
Software: *
SellInstallSupportSub-contract with another organizationNot Applicable
Training: *
SellInstallSupportSub-contract with another organizationNot Applicable
Support: *
SellInstallSupportSub-contract with another organizationNot Applicable

Certify & Accept

I hereby certify that I have answered all questions completely and truthfully.