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The Eftia Partner Program Application Form

Instructions: Please complete the following form and then click 'Submit Application.'
All * fields are mandatory.

*What type of partnership are you interested in applying for?



How did you hear about us?



If Other 

Company Information

* Company Name:

* Address:

* City:

* Prov/State:

* Postal Code:

* Country:

Website:


* Please provide a brief company and product overview:


* Date Company Established:

Parent Company:

Number of Locations:

* Number of Employees:

* Number of Customers:

* Public or Private?


Partnering Information


Please specify value of your organization's OSS revenue (in US dollars):
* 2002
* 2003
* 2004

Are you currently working with any OSS application vendors?
If yes, then who: 

* Do you have existing clients that require an OSS solution today?

Points of Contact

Application Contact:
* Name:
* Title:
* Phone:
Fax:
Email:
 
Sales & Marketing Contact:
   
* Name:
* Title:
* Phone:
Fax:
Email:


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