PARTNERFIRST Application

Company Name:

First Name:

Last Name:

Title:

E-mail:

Phone:

Street:

City:

State:
N/A Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Flordia Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Country/Region:
Please Select United States Canada Europe Asia Australia Other / International

Website:

Please provide a brief overview of your company and the products/services you provide (250 word max):

Which of the following best describes your primary business?
VAR Content Delivery Network Application Network Delivery Solution Platfom Systems Integrator Hosting Provider Managed Service Web Agency

What is your primary target customer size?
Small Business (<100 users) Medium Business (100-500 users) Large Business (>500 users)

What market segments do you target? (select all that apply by holding the ctrl key):
Manufacturing/Distribution High Technology Media & Entertainment Health/Medical Retail Transportation Banking/Finance E-Commerce Other

What are your core value propositions? (250 word max):

Why would you like a partnership with Gomez? (250 word max):

Annual Company Revenue :
< $1mm $1 - 10mm $11 - 50mm $51 - 250mm > $250mm

Number of Employees:
1 - 20 21 - 50 51 - 100 101 - 200 > 201

How long has your company been in business?

How many sales people do you have?

Number of customers using your product/services?

Do you have any integrations with existing Gomez customers?
Yes No

If yes, please specify customers:

Are you interested in reselling Gomez Products and Services?
Yes No Need More Information

What is your level of Gomez proficiency?
None Low - Less than 3 months Med - 6 months High - More than 6 months

Is your company using Gomez products today?
Yes No

List key Joint Customers:

Do you have a product that you are looking to integrate?
Yes No

What other Performance Management Companies does your company partner with?

By submitting this form, the respondent warrants that he/she has the authority to submit this information and that the information provided is accurate and true.