EMC Insignia : How to Become a Partner

My company is interested in becoming an EMC Insignia Channel Partner and understands the information provided in this document will be reviewed by only authorized EMC or Distributor personnel and maintained in strict confidence.

EMC Velocity Referral Information

How did you hear about the program?*

If other, please specify:

General Reseller Information

Full Legal Business Name:*

Parent Company (If Applicable):

Address 1*

Address 2

City*

State/Province

ZIP/Postal Code*

Country*

Phone*

FAX*

Corporate URL*

President*

Email address*

Primary Sales Contact*

Email address*

Business and Organizational Structure (Please check appropriate box):

Sole Proprietorship

Public Corporation

Partnership

Private Corporation

8A Agency

Date Founded

Subsidiary Company

Please check which of the following partners you have authorization with and list authorization level.

Adaptec

Level

Cisco

Level

Citrix

Level

IBM

Level

Iomega

Level

McAfee

Level

Microsoft

Level

Network Appliance

Level

Symantec

Level

Market and Industry Specialization

Do you have an SMB practice?*

% of Total Revenue*

Market #1*

% of Total Revenue*

Market #2*

% of Total Revenue*

Market #3*

% of Total Revenue*

Are you currently an EMC Velocity Reseller?*

If yes, what level?

Partner Agreement Terms*

I am submitting this form to verify interest in the Velocity program.*

By checking this box and submitting this form to EMC, I have read, understand, and agree to the terms included in the EMC Velocity SMB Solution Provider Agreement.*

How to Become a Partner

Submit this form and read and agree to the terms of the EMC Velocity SMB Solution Provider Agreement to become a Velocity SMB Partner

EMC Velocity Referral Information

General Reseller Information

Business and Organizational Structure (Please check appropriate box):

Please check which of the following partners you have authorization with and list authorization level.

Market and Industry Specialization

Partner Agreement Terms*