Please complete this preliminary application form below. Please note, required fields are marked with an asterisk(*).

Company Name*:
Parent Company Name:
Name*:
Job Title/Position:
Email Address*:
Address Line 1*:
Address Line 2:
Address Line 3:
City*:
State/Province*:
Postal Code/ZIP*:
Country*:
Telephone Number*: include area code	( )
Fax Number: include area code	()
Company URL:
Primary Industry Focus:
Year Company Established*:
Number of full-time employees:
Total Revenue (in millions US$) in most recent fiscal year

Business Profile

Please provide a brief description of your company and products:

What type of partner relationship are you seeking with Epiplex500? Value Added Reseller Authorized Consulting Partner OEM Partner

If applicable, from what reseller do you currently obtain Epiplex500 products for resale?

epiplex500 Sponsor: Please list any epiplex500 employees that you have been working with or contacted regarding a partnership:

Geographic coverage:

Please select the products most relevant to the proposed partnership:
(please choose at least one)

Business Process Performance/Analysis
Knowledge Provisioning
Enterprise eLearning