Please complete the Channel Partner application below. An InduSoft representative will contact you soon.

1. General Information
Program(s) you are applying for:

OEM Distributor Independent Software Vendor System Integrator

Company Name:
Mailing Address:
City:   State:
Zip Code:   Country:

Shipping Address:
(if different from above)
City:
  State:
Zip Code:
Country:
President:
   

Primary Contact for Program:
Title:
Email Address:

Phone:
  Ext:  
Fax:
 

Secondary Contact:
Title:
Email Address:

Phone:
  Ext:  
Fax:
 


2. Company Profile
Please provide a general description of your company and the services you provide:

Number of years in business:
  Number of full-time employees:  
Current Annual Revenue (in U.S. $):
Less than 100K
100K - 500K
 500K - 1 Million Over 1 Million

Sales Distribution (percentage):

North America:
  Asia/Pacific Rim:

South America:
  Africa:  
Europe:
  Other:  

Primary Markets (percentage):

Automotive:
  Packaging:

Biotech:
  Pharmaceutical:

Chemical/
Specialty Chem:
  Power/Energy Mgt:

Consumer Products:
  Pulp & Paper:

Discrete Manufacturing:
  Rubber/Misc. Plastics:

Electronics:
  Semiconductor:

Food & Beverage:

  Utilities:

Metal & Mining:

  Water/Wastewater:

Oil & Gas:

  Other:

Who are your major competitors? 

What trade shows do you usually attend?

What trade organizations do you belong to?

How did you hear about the InduSoft Business Partners Program?

Advertisement
Direct Mail
Trade Show
 Referral
InduSoft's Web Site Other Web Site:
Other:   

3. Product Experience
Please describe your experience with InduSoft's software:

What competitive software products have you used?

4. Partner Product Information (if applicable):

Product Name:

Product Description (in 100 words or less):

How does your product incorporate or integrate with InduSoft's products (now or in the future):

Product Classification:

Software
Driver/Server
System Hardware
I/O Device
Other

Operating Ststens Supported:

Windows XP
Windows NT
Windows 95/98
Windows 2000
Windows CE

Foreign Languages Supported:

Would you like the above Partner Product Information published on InduSoft's website? 

Yes   
No