New Partner Application

*Legal Status:—Please choose an option—LLCSole ProprietorPartnershipC-CorpS-Corp

*Company Name:

Company DBA (if different):

*Company Address:

*Employer Identification Number (EIN):

*Company Website:

*Business Model:VARMSPMSSP

*Number of Employees:—Please choose an option—1-1010-5050-100100-10001000+

*Date Business Was Established:

D&B Number:

*A/P Contact Person & Portal Admin:

*A/P Contact Person & Portal Admin Email (This email will receive an invitation to our portal once the account setup process has been completed):

*Email Address for Invoices:

*Company Phone:

*Sales Order Confirmation Email Address:

*Do you have an open quote with exclusive?:—Please choose an option—YesNo

*Applying for credit terms?:—Please choose an option—YesNo (By selecting No you are opting in to a Pre-pay account that will be able to transact via ACH Wire or Credit Card)

*Vendors you are currently partnered with:FortinetJuniper NetworksNuaware/DockersNozomi NetworksProofpointRackmount.ITRuckus NetworksSentinelOne

*Firewalls/Endpoints under management?:—Please choose an option—1-100100-1,0001,000-10,00010,000+

*Typical End User Business Size?:—Please choose an option—SMBMid-MarketEnterprise

*Upload Field: W-9:

Upload Field: Sales Tax Exemption Certificate:

Upload Filed: Other:

Your Company Name*:

Your Contact Name*:

Your Email*: