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Terabeam Wireless VAR Program Application

Partners Links: Distributors; Value Added
Resellers; OEM Partner Support; Solutions Partner

Thank you for taking a moment to complete Terabeam's VAR Program application. We request that you complete as much of the form as possible. Please note however, you will be required to provide missing information at a later date in order to complete the application process. Once you have completed the form, a VAR representative will contact you to discuss potential opportunites.

Company Information
Company Name
Address
City
State
Zip
Web site
Type of Company
	If Other:
Type of Business
	If Other:
Date Established
Annual Revenue
Number of Employees
Primary Contact
Name
Phone
Email
Technical Contact
New Contact Use prime
Name
Phone
Email
Accounts Payable Contact
New Contact Use Prime Use Tech
Name
Phone
Email
Market Presence
Current Vertical Markets	Medical/Healthcare Education Service Provider State or Local Government Federal Government Construction/Engineering	Financial Hospitality Energy Corporate Campuses Other:
Current Regional Markets	Eastern US Central US Western US Canada Mexico South America Central America	Western Europe Eastern Europe Asia Australia Africa Middle East Other:
Value Add	Design Site Survey Install Construction	Network Integration Service & Maintenance Other:
Wireless Products currently distributed, installed and/or serviced:
Unlicensed
Licensed
Comments/Questions Please provide any other information or questions you feel would pertain to your desired relationship with Terabeam Wireless. Thank You.

(NOTE: A copy of this application will be sent to the prime contact's email)

Terabeam Wireless VAR Program Application

Company Information

Primary Contact

Technical Contact

Accounts Payable Contact

Market Presence

Comments/Questions