Channel Program Application

Contact Information

Full Legal Company Name:
Your First Name:
Your Last Name:
Phone:
E-mail:

References
Please identify at least two customer references that ExpeData digital solutions may contact as part of the application review process. The reference accounts do not need to involve ExpeData specific software.
Reference 1
First Name:
Last Name:
Title:
Company:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
E-mail Address:
Describe the solution that you provided this customer. (Please limit your response to 1500 characters):
Reference 2
First Name:
Last Name:
Title:
Company:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
E-mail Address:
Describe the solution that you provided this customer. (Please limit your response to 1500 characters):

Primary Alliance Contact
This individual will receive the ExpeData Alliance Program contracts and be the main contact for establishing this alliance.
First Name:
Last Name:
Title:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
E-mail Address:

Address:

City:

State/Province:

Zip/Postal Code:

Country:

Web Site Address:

Year Company Founded:

Is your firm:

Public
Private

Number of Employees:

Number of Customers:

Revenues & income for most recent fiscal year (please specify currency):

Please provide a brief overview of your company's products or services. (Please limit your response to 1500 characters):

Please describe why you want to establish a relationship with ExpeData digital solutions. (Please limit your response to 1500 characters):

Do you have a partnership with any other application service providers? If yes, which one(s)? (Please limit your responses to 1500 characters):

Which vertical industries do you specialize in?

Please list the number of clients you have in each of these regions.

North America
Europe, Middle East and Africa
Latin America
Japan
Asia Pacific