Partner Request Form

Thank you for your interest in becoming a Metrix Partner.

Please complete / update the following form.

 * Denotes required fields.

Company Information

Company:	*
Address:	*
Address2:
City:	*
State/Province/Territory:	*
Postal Code:	*
Country:	*
Parent Company:
Ticker Symbol:
Organization Type:	Corporation Public Corporation Private Partnership Sole Proprietorship
Number of Employees:	*
Phone Number:	*
Fax Number:	*
Web Site:
Years in Business:	0 - 2 2 - 5 5 - 10 10 - 20 20 or more  *

Primary Contact

First Name:	*
Last Name:	*
Email:	*
Phone Number:	*
Fax Number:	*

Product Information

What do you consider to be your primary Business Focus? Application Software Dealer or Distributor Value Added Reseller Consultant Other  *
Please describe one or more of your primary product(s) and/or offerings. *
Product Description:
Product Description:
Product Description:
Please describe your Value proposition. What unique value do you bring to Metrix, Inc. and/or your customers? *
Value Proposition: