A. General Information: |
| Company Name (Legal entity): | |
| Company Registration Number: | |
| VAT Number: | |
| Company Web Site: | |
| Ownership: |
| CC |
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| (Pty) Ltd: |
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| Partnership |
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| Sole Prop |
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| Year(s) established: | |
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B. Business Alliance Partner Principle Contact: |
| Title: |
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First Name:
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Surname:
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Position:
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Tel. Direct:
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Mobile:
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Email:
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C. Company Details |
| Physical address: |
Street Address:
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City:
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Country:
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Province:
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Postal Code:
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| Are your postal and physical addresses the same? If yes, you do not need to complete the "Postal address" section below. |
| Yes No |
| Postal address: |
Street Address:
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City:
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Country:
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Province:
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Postal Code:
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D. Business Profile: |
| Description of the company business: |
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| Describe the key services of the company: |
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| Primary markets of the company (eg. Healthcare;Financial;Government,etc.): |
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| 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
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| Would you like to be part of our security mailing list? |
| Yes No |
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How did you hear from us? | |
Specific products interested in: | |
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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: | |
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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): | |
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G. Primary Contacts: |
| Sales Director/Manager: |
| Title: |
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First Name:
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Surname:
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Position:
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Tel. Direct:
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Mobile:
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Email:
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| Managing Director/Manager: |
| Title: |
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First Name:
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Surname:
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Position:
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Tel. Direct:
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Mobile:
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Email:
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| Accounts Department: |
| Title: |
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First Name:
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Surname:
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Position:
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Tel. Direct:
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Mobile:
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Email:
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| Technical/System Engineer: |
| Title: |
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First Name:
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Surname:
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Position:
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Tel. Direct:
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Mobile:
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Email:
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| Director/Owner: |
| Title: |
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First Name:
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Surname:
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Position:
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Tel. Direct:
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South African ID/Passport number:
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Mobile:
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| Banking Details: |
Bank Name:
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Branch:
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Account Number:
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Account Type:
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Account Name:
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