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Please fill out the following form, as completely, as you can. By providing as much information as possible, it will expedite the process of your company becoming an SoftShadowSecurity Business Partner. If you have any questions or need any assistance, please email SoftShadowSecurity or call us at: 603.380.6178. After submitting the form, we will contact you shortly. Thank you for your interest in becoming an SoftShadowSecurity Business Partner!

(* Indicates that the entry is required)

1. Applicant Information:
Company's Legal Business Name*:            
Doing Business As Name:                    
Company Street Address*:                   
Street Address (Contd.):                   
Zip Code:                                  
P.O. Box:                                  
Date Business Founded:                     
Business Telephone*:                       
Business Fax:                              
Contact Name*:                             
E-mail Address*:                           
Website Address (URL):                     
Parent or Holding Company:                 

2. Business Partner Type (Select the one Business Partner type 
below which best describes your primary business):

3. Location is a:

4. Personnel: 
Total number of full-time employees:       

Please indicate the number of employees which are a particular type:
(Please enter 0 if none of are a particular type) Outside Sales Reps: Inside Sales Reps: Systems Engineers: Technical Support Reps: Other: Please list the names of your key principals, officers and owners below:
% Ownership

5. Hardware Reseller Vendor Authorizations:    
(Please select all that apply)
IBM Sun HP Cisco Nortel Other
If Other please specify:                       
6. Company Profile:
Please provide a non-confidential description of your primary business,
products and services, and a brief history of your company:

7. Value-Added Solutions (if applicable) : 
Primary Software Application Solution:    
Developer Name:                           
8. System/Network Integration Vendor Certifications:
(Please check all that currently apply)

Novell SCO Lotus Notes Windows NT Cisco Other
If Other please specify:                  
9. Targeted Customer Market:
(Please check your primary market)

10. Industry Segment:
(Please check your primary industry segment)

If Other please specify:                    
11. Annual Sales Revenue:
(Please enter 0 if applicable)
Prior Year Total Sales:                   $K
Current Year Projected Total Sales:       $K

Mention Percentages:
Services :                                 
Consulting :                               
Network/Systems Integration:               

Do you sell to resellers?

If Yes, what percent of your sales are to resellers versus end users? %
12. SoftShadowSecurity Product Sales Forecast:
How many PlzMayI PlzMayI Appliances do you plan to resell over
the next 12 months?
Number of PlzMayI Appliances ($3599): 
13. SoftShadowSecurity Marketing Plan for SoftShadowSecurity Services:
Please provide a non-confidential description of how you arrived at, and
will execute, the sale of the above projected volumes of PlzMayI

Your Privacy:

The data you provide here may be used to provide you with information from PlzMayI or our business partners about our products, services or activities. Please do not use the information collected here for future marketing or promotional contacts or other communications beyond the scope of this transaction.

Business Partner Agreement:

Please download the SoftShadowSecurity Business Partner Agreement.(PDF Format). Please review and sign the agreement if you agree to the terms and conditions and fax the signed agreement to the Attn: Sales Department at 603.380.6178 . Thank you!

Applicant Certification:

By submitting this application, I certify that I have read and agree to the terms and conditions of the PlzMayI Business Partner Agreement and that the information contained herein is true and correct. Should any of the information change, I will inform PlzMayI in writing. During that time, and subsequent PlzMayI approval, I agree to abide by the terms and conditions of the SoftShadowSecurity Business Partner Agreement.

Additionally, I understand and agree that as an PlzMayI Business Partner, I must actively promote and resell PlzMayI services during the contract period of the SoftShadowSecurity Business Partner Agreement. Failure to do so may result in the SoftShadowSecurity Business Partner Agreement not being renewed.

Note: Only an Authorized Company Officer may authorize the submission of this application to join the SoftShadowSecurity Business Partner Program.

Authorized Company Officer Name*:          
E-mail Address*:                           

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