Ascentn Partner Program Registration Form
 
The following information is requested to help evaluate a potential alliance between your company and Ascentn. All information will be treated as confidential.
 
Fields denoted by an asterisk (*) are required.
  
     
  Contact Details  
 
Primary Contact Information      
First Name:(*) Last Name:(*)
Business Title:(*) Business Email:(*)
Business Phone:(*) Business Fax:
Company Contact Information      
Company Name:(*) Website:(*)
Street:(*) City:(*)
State/Province: Post Code:(*)
Country(*) VAT Number:
       
 
  Company Details  
 
Company Type:   Company Funding:
Trading Symbol: Years in Business:
Approximate Annual Revenue:    
Number of Fulltime Employees:    
Key Industry Focus: Financial Service Industry
Telecommunications
Others
 Manufacturing
Government		 Healthcare & Life Science
Retail
Territory of Intrest:      
Other Alliances: Key Customers:
Microsoft Partnership Level: (*) None
Registered
Certified
Gold
 Microsoft Competence: (*) Business Process and Integration
Custom Development Solutions
Data Management Solutions
Information Worker Solutions
ISV / Software Solutions
Learning Solutions
Microsoft Business Solutions
Microsoft Dynamics
       
 
  Alliance Details  
 
Program Category: (*)
Program Level: (*) Select                  Silver               Gold
Envisioned relationship with Ascentn: (*) Reseller
Solution Provider
Technology Provider
Sub-Contractor
Others
Please describe current or past activities with Ascentn: (*)
Describe your business plan or motivation to become an Ascentn Partner: (*)
Other Information: