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IceWEB Online Channel Partner Program

IceMAIL Channel Partner Application

Thank you for your interest in the IceMAIL Channel Partner Program. In order to process your application to the program, we need some essential information about you and your company.

Step 1: Company Information

Your First Name:

Your Last Name:

Your Email Address:

Your Position/Title within Company:

Official Company Name:

Company Doing Business As (if applicable):

Federal Tax ID:

DUNS:

How Many Employees Do You Have:

Approximate Corporate Revenue for the
last 12 months:

Street Address:

City/Village:

State/Province:

Zip / Postal Code:

Country:

Phone:

Fax: (optional)

Comments:

Step 2: About Your Company and Customers

Please Describe What Your Company Primarily Sells :

What Size Business Do You Normally
Sell To:

	Small / Home Office <5 users
	Small Business < 25 users
	Business <100 users
	Medium Corporations <250 users
	Business <1000 users
	Enterprise Corporations >1000 users
	State & Local Government
	Federal Government, Dept. of Defense, Education

Please Describe How You Normally
Sell and Advertise:

Step 3: Agreement

I agree that I am duly authorized by my company to request Affiliate status with IceWEB. I further authorize IceWEB to perform a brief background and/or credit check of my company although this will not be the sole reason for acceptance or decline of this application. I acknowledge that I will be contacted by a representative at IceWEB regarding this application to further explain the Channel Partner Program and the IceWEB Online suite of services. If my application is approved, IceWEB will send the official IceMAIL Channel Partner Areement to my company address for signature.

Notes, comments, or clarifications on your application: