LaunchNet - Partners Referral Program

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Thank you for your interest in becoming a LaunchNet Referral Partner. Please fill out this form and a member of our Partner Team will contact you shortly.

Business Contact Information

First Name:	Last Name:
Business Name:	Business Web Site:
Address:
City:	State:	Zip Code:
E-Mail:	Phone:

Business Background

Years in Business:

Type Of Business:

Other Type of Business:

Which of these services does your business offer? Check all that apply:
LAN/WAN Design
LAN/WAN Support
Security
Phone System/VoIP
Software Implementation/Training
Web/Internet
Other:

How many employees do you have?
1-4 5-10 11-15 16-30 51+

What are their roles? Check all that apply:
Sales Administrative Technical

What is your service area?

If Regional, check all that apply:
Northeast Southeast Midwest Southwest Northwest West Coast

What are your core verticals? Check all that apply:
Real Estate Software/Engineering Medical/Dental Professional Services Financial Retail Health Care Manufacturing Legal Insurance Utilities Hospitality/Food Services Other:

Are you a certified partner of any of the following firms? Check all that apply:
Microsoft Sun Novell IBM Cisco Nortel HP Compaq Apple/Macintosh 3Com Adobe Lucent Checkpoint Netscreen Sonic Citrix Oracle Siebel Sybase Other:

Do you currently refer and use other Service Providers?
Yes No If Yes, Who?

How many clients do you currently serve?
Under 5 6 – 15 16 – 30 30+

What are you most interested in from LaunchNet?
ADSL SDSL T1 VoIP Private Network Hosting

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