Partner Application
Please complete the following Partner request form details.
Your submission of this form will constitute your consent to the collection and use of this information as defined by our
privacy
statement.
We currently do not offer online service requests within United States, Please contact our sales group.
Your Details
Partner Program :
Please Select Program
Solution Provider
Reseller
SME Reseller
Developer
Business Type :
Please SelectType
Accountant
Bookkeeper
Professional Service
IT Provider
Consultant
Reseller
Integrator
Developer
ASP
Other
First Name :
Last Name :
Your Telephone :
Email :
Company Name :
ABN:
Address :
City :
State :
Country :
United States
Postal Code :
Web Site URL:
Company History
Years in business:
Gross Revenue:
# Existing Clients:
Total # Employees:
# Sales Staff:
# of Offices:
Business Information
Do you have an immediate sales opportunity that would involve a VillageMall solution?
Yes
If yes, please describe the opportunity in the box below. For instance, what is the budget available? The number of users? What is the business problem the opportunity would solve? What is the time frame for a final decision
.
Please list any partnerships that your company has with other providers:
Customers (Target Market)
Gross Revenue (customers)
less than $1M
$1 -$10M
$11 -$25M
$26 -$50M
# Employees (customers)
>
Sole Trader
1 to 10
10 to 50
50+
Projected # new customers per year
1 to 10
10 to 100
100 to 1000
1000+
Please describe your interest in partnering with VillageMall
Enter displayed verification code.