ClearPath Networks Partnership Program Application

* Indicates required fields

Contact Information
Select a Region:	*
Company Name:	*
Company Country:	*
Company Address:	*

Company City:	*
Company State:	*
Company Zip/Postal:	*

First Name:	*
Last Name:	*
Job Title:	*
E-mail Address:	*
Additional E-mail Addresses:
Company Phone: (XXX-XXXXXXX)	*
Work Phone:		#
Fax: (XXX-XXXXXXX)

Company Background
Company Type:	*
URL:	*
Total Number of Company Locations:	*
Number of Employees:	*
Number of Direct Sales Employees:	*
Number of Indirect Sales Employees:	*
Number of Years in Business:	*
Annual Revenue in $:	*
Preferred Distributor: (Select all that apply)	*
If "Other" please specify the distributor:	*
What is your Market Focus? (Select all that apply)	*
Based on number of employees, what is the average company size of your target customer?	*
List the security products and services you currently sell:
Are you authorized to sell to government agencies?	*	Yes No
If "Yes" please list the agencies:	*

List any ClearPath contacts you're working with to become a partner:

Online Ordering & Partner Portal Info
Upon submission of your Partner Application you will be enrolled in the Bronze Partner Program and will have access to ClearPath's SNAP View On Demand Online Ordering System. You will receive an e-mail with an auto-generated Partner ID which can be used for obtaining a 5% discount off MSRP. You will be contacted by a ClearPath Business Development Manager about this and other Partner Programs which can provide larger discounts, marketing programs and other incentives.
Upon approval of your Partner Application you will have access to ClearPath's Partner Portal where you can access Partner Tools & Resources. Please select a Channel Code as Partner Portal Login.
Channel Code: (Maximum of 10 characters)