Partner Application

Please take a minute to provide us with the information necessary to process your application.

Please note that the items marked with an asterisk (*) are required.

Company Information
*Company
*Address
*City
*State/Province	--- Select State/Province --- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming --- --- CANADA --- --- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon
*Zip/Postal Code
*Country	--- Select Country --- United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antartica Antigua and Barbuda Antilles Netherland Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brasil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Estonia Ethiopia Faeroe Islands Falkland Islands (Malvinas) Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey C.I. Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey C.I. Jordan Kazakhstan Kenya Kiribati Korea Dem. People's Rep of Korea Republic of Kuwait Kyrgyzstan Lao Peoples Democratic Republi Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxemborg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Fed. States of Moldova Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Neutral Zone (Saudi/Iraq) New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Panama Canal Zone Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.A.E. U.S.Minor Outlying Islands Uganda Ukraine United Kingdom Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin Islands (British) Virgin Islands U.S. Wallis and Futuna Islands Western Sahara Yemen Republic of Yugoslavia Zaire Zambia Zimbabwe
*Telephone
Fax
*Email
Web Address
How did you learn about Managed Objects?	--- Please Select --- Email Letter Friend Company Representative Co-worker Other (please specify below)
Please specify 'other' if chosen above:
Business Information
Partner Type:	-- Please Select -- Consultant Developer Distribution OEM Consulting Services Systems Integrator Trainer VAR/Re-seller Other (please specify below)
If you specified 'consultant' or 'other', please provide detail:
Geographic area your organization serves
US: Northeast Northwest Midwest Southeast Southwest West International: Canada Latin America Asia Pacific Europe, Middle East, and Africa
Vendor Partnerships
What other vendor software products are you authorized to sell?
Target Markets
What vertical markets does your organization target? (check all that apply)
Accounting Financial Publishing Automotive Healthcare State/Local Government Communications Insurance Transportation Education Legal Utilites Federal Government Manufacturing Other
Contact Information
Primary Contact
Name Title Tel (+ext.) Fax Email

All information is confidential and will only be used for internal processing.