Partner with Instantis, Inc.

We invite you to join the Instantis community of partners. Please provide as much information as possible to ensure quick evaluation. Fields marked with an asterisk (*) are required.

NOTICE: PLEASE DO NOT SUBMIT ANY CONFIDENTIAL INFORMATION TO INSTANTIS. UNLESS YOUR COMPANY HAS ENTERED INTO A NON-DISCLOSURE AGREEMENT WITH INSTANTIS, ALL INFORMATION PROVIDED WILL BE ASSUMED TO BE NOT CONFIDENTIAL.

Contact Information
Salutation:
First Name*:
Last Name*:
Title*:
Company Name*:
Address 1*:
Address 2:
City, State, ZIP Code*:
Country*:
Telephone*:
Facsimile:
Email*:
Web Address*:
Desired partner program*:

About Your Company

1.	Company Description* Please provide a brief overview of your company and the products/services you provide.

2.	Target Market Please provide a brief description of your target market and customer base.

3.	Customers Please list your top 3 customers.

4.	Business Relationships/Alliances Please list companies you currently partner with.

5.	Competition Please list your primary competitors and briefly describe how you position yourself against them.

6.	Company Size and Revenue

Is your company publicly traded?

Yes

What is your stock symbol?

If private, who are your venture sponsors?

Total Customers Worldwide:

Total Number of Employees:

What is your annual revenue (in US$)?

2004 (Projected)

2003

2002

Value Proposition

1.	Please describe the proposed relationship with Instantis. Please include how your product and services will interrelate with Instantis offerings*.

2.	Please list any customers who have identified our joint solutions as a functional requirement, or likely prospects that may benefit from such a solution.

3.	What market segments do you work with?

Other

How did you find us?*

If other please specify

Would you like to receive email about Instantis news and events?*

Yes

Questions/Comments: