Online Partner Registration


If you require more information on the partner program, please click here.

* Please be advised that all the fields are required to be completed.
If any option is missed the system won't accept your form.

A. General Information:
Company Name (Legal entity):
Company Registration Number:
VAT Number:
Company Web Site:
Ownership:
CC
(Pty) Ltd:
Partnership
Sole Prop
Year(s) established:

B. Business Alliance Partner Principle Contact:
Title: Province:
Postal Code:
Are your postal and physical addresses the same? If yes, you do not need to complete the "Postal address" section below.
YesNo
Postal address:
Street Address:
 City:
Country:
 Province:
Postal Code:

D. Business Profile:
Description of the company business:
Describe the key services of the company:
Primary markets of the company (eg. Healthcare;Financial;Government,etc.):
Are you an official Value-Added Reseller of other products?
Anti-Spam
Anti-Virus
Application Security
Biometrics
Business Continuity/Disaster/Recovery
Compliance
Content Monitoring/Filtering/Email/IM Security
Encryption/PKI/Digital/Certificates
Firewalls
Identity & Access Management
Internal Security/Network Security
Intrusion Detection/Prevention
IT Forensics
IT Helpdesk & Support
Legislation & Standards/BS7799/Certification
Managed Security Services
Patch Management
Penetration Testing/Risk & Vulnerabilty Assessment
Physical Security
Remote Access
Secure Storage
Security Policy/Tokens/Web Services
Security Training/Awareness/Education
Single Sign-On
Storage Security
Unified Threat Management
VOIP Security
VPN
Wireless/Mobile Security
None of the above
Would you like to be part of our security mailing list?
YesNo
How did you hear from us?
Specific products interested in:

E. Service Profile:
Please provide us with the amount of people in your company:
Inside Sales amount:
Outside Sales amount:
Technical Support amount:
Other amount:

F. Sales Projections:
Please provide us with an approximate amount of your customers per category:
Enterprise (+1200 users):
SME (501-1199 users):
SMME (101-500 users):
SOHO (1-100 users):

G. Primary Contacts:
Sales Director/Manager:
Title:

G. Primary Contacts:
Sales Director/Manager:
Title:
First Name:
 Surname:
Position:
 Tel. Direct:
Mobile:
 Email:

Managing Director/Manager:
Title:
First Name:
 Surname:
Position:
 Tel. Direct:
Mobile:
 Email:

Accounts Department:
Title:
First Name:
 Surname:
Position:
 Tel. Direct:
Mobile:
 Email:

Technical/System Engineer:
Title:
First Name:
 Surname:
Position:
 Tel. Direct:
Mobile:
 Email:

Director/Owner:
Title:
First Name:
 Surname:
Position:
 Tel. Direct:
South African ID/Passport number:
 Mobile:

Banking Details:
Bank Name:
 Branch:
Account Number:
 Account Type:
Account Name:

H. AfricaSD Account manager:
The person which you have been in contact with at AfricaSD:
I agree to and have read the Terms and Conditions
All information gathered by Africa Solutions Distributor is held with strict confidentiality for internal use only and will not be sold.
* Please be advised that all the fields are required to be completed.
   If any option is missed the system won't accept your form.