Partner Application - Nirix Technology

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	Partner Program Application
	Join the ranks of VARs and Managed Service Providers who are reaching their target audience faster than ever before and driving revenues through guaranteed subscription style hosting services. Complete the form below to be contacted by a Nirix Channel Manager who will be able to answer any additional questions you may have and get you enrolled in the innovative Nirix Channel Partner Program.

Contact Information

Company Name:*

Website:

First Name:*

Mailing Address:*

Last Name:*

City:*

Title:

Postal Code:*

Telephone:*

Province:*

Email:*

# of branch locations:*

Business Type:*

Number of products/services sold:*

Services Provided:*

Years in Business:*

Employee Count:*

Annual Sales:*

Average Customer Base:*

Average Customer Seats:*

Your geographical focus:*

Preferred method of contact:*	Phone Email
How did you find out about Nirix?*