Partner Interest Form
 

First Name*
Last Name*
Company*
Title	General Manager Company Owner Marketing Manager Sales Manager Finance Manager Brand Manager IT Manager Executive Asistant Specialist Project Manager Other Other:
Company Adress*
City*	Adana Adıyaman Afyon Aksaray Amasya Ankara Antalya Ardahan Artvin Aydın Ağrı Balıkesir Bartın Batman Bayburt Bilecik Bingöl Bitlis Bolu Burdur Bursa Denizli Diyarbakır Çanakkale Çankırı Çorum Düzce Edirne Elazığ Erzincan Erzurum Eskişehir Gaziantep Giresun Gümüşhane Hakkari Hatay Isparta Iğdır İçel İstanbul İzmir Kahramanmaraş Karabük Karaman Kars Kastamonu Kayseri Kilis Kocaeli Konya Kütahya Kırklareli Kırıkkale Kırşehir Malatya Manisa Mardin Muğla Muş Nevşehir Niğde Ordu Osmaniye Rize Sakarya Samsun Siirt Sinop Sivas Tekirdağ Tokat Trabzon Tunceli Uşak Van Yalova Yozgat Zonguldak Şanlıurfa Şırnak
Phone*
Fax*
E-Mail*
Web
You are interested in*	Partner Referral Program Authorized Reseller Program Authorized Solution Provider Program
Toptal number of employees*	1-5  6-10 11-20 21-50 50+
Employees dedicated to sales and marketing*	1-2 3-5  6-10 11-20 20+
Your company is established in	/ /
Other products you are authorized to sell?
Is your company developing any software	Yes No
Your target customers*	Small Business            Mid-sized Business     Enterprise	Government Multi-nationals Other
Your company is	A business office a showroom
m2
Your Turnover	2006 2007 2008
Percentage of software and support in turnover	%0-10 %11-25 %26-50 %51-75 %76-100
Why are you interested in Verimax (Max 100 words)