Partner Application Form

Information on this form will be treated as confidential and will only be used by HID Identity for the purpose of appraising candidacy for the partner program and, if approved, for creating a useful profile as an Asure ID Secure Partner.

HID Identity will only use the information submitted to better serve your needs and answer your questions. It is our company policy NOT to make your information available to any third parties. (Items marked with an asterisk * are required)

Which Asure ID SecureTM Partner program are you applying for? (check one)

Secure Elite Partner (Sales and services to end users and resellers)
Secure Distributing Partner (Sales and services exclusively to resellers)


Basic Company Information
Business Name: *
Address: *
City: *
State/Province:
Zip/Postal Code:
Web Address:
Main Contact Name: *
Title: *
Phone Number: *
Fax Number:
E-mail Address
Business Description
Please describe your business:
(50 words or less)		 *


Revenue*
Please identify the main sources of revenue for your business:
Computer Software
Computer Hardware
Systems Integration
Other Computer Services
Printer Sales and Support
Printing Services
Card Issuance Services
Other
Explain:


Annual Revenue: (US$) Check one*
More than $100 million
Between $10 million and $100 million
Between $5 million and $10 million
Between $1 million and $5 million
Less than $1 million


Employees:
Total number of employees
Number of sales employees
Number of technical employees


Contact Information
Primary Contacts for HID Identity
  Name Title Phone E-mail
Sales Contact
Marketing Contact
Technical Contact
Admin Contact
Describe how in your opinion HID Identity technology would fit within your business model?*