Celestix Appliance Partner Program Application

This information is confidential and for the sole use of the Celestix Networks, Inc. Marketing Team.

Please submit the form below to apply for the Reseller Partner Program. After submitting this application form a Celestix Networks sales person will contact you personally via phone or email.

General Information about you and your company

General Information about You and Your Company

Firstname:
Lastname:
Title:
Company:
Address 1:
Address 2:
City:
State:	(if outside U.S.A.)
Zip:
Country:
Phone:	(no spaces or dashes)
Fax:	(no spaces or dashes)
E-mail Address:
Your Web Site URL:	http://

Company Contacts

Marketing Person:	Email: optional
Sales Contact:	Email: optional
Technical Support:	Email: optional
Accounting Person:	Email: optional

How did you learn about this reseller program?

Celestix Web Site

Celestix Sales Person

Trade Publication/Name of the Publication

Trade Show/Name of Trade Show

Distributor/Name of the Distributor

Promotional Code:

About Your Company

Please select your company's type of business:

Value Added Reseller
Systems Integrator
Distributor
Developer

IT Consultant
ASP (Application Service Provider)
ISP (Internet Service Provider)
Others

What is your companies annual sales ? (gross sales)

less than $1m/year
$1-5m/year
above $5m/year

Year Established:

Number of Employees:

What geographic markets do you target?

Local
Regional
National
International

What will be your expected Celestix's business over the next 12 month?

below 50 Celestix Servers
50-499 Celestix Servers
more than 500 Celestix Servers