triCerat, Inc.

EMEA:

+44 (0) 1494-616102

International:

+1 (410) 715-4226

sales@tricerat.com

Enrollment Form Please have the following information ready in filling out this form: Company Information: Basic information needed to create a partner account for your organization. Contact Information: Information on key individuals that will be triCerat's contact. Business Information: Revenue data, areas of expertise, and technologies and services offered. *Required Fields
*I am interested on the following triCerat Partner level: Registered Silver Gold
Company Information:
*Company Name:
*Company CEO:
*Address:
*City:
*State/Province:
Zip/Postal Code:
*Country:
*Telephone: (include country/area code)
*FAX: (include country/area code)
*Email:
*URL:
Do you have offices in other locations?	Yes No
If yes, please list other locations:
Contact Information:
My Contact Information:
*First Name:
*Last Name:
*Title:
*Telephone: ext.
*Email:
Sales Contact (if other than the person filling out this form.)
First Name:
Last Name:
Title:
Telephone: ext.
Email:
Technical Contact (if other than the person filling out this form.)
First Name:
Last Name:
Title:
Telephone: ext.
Email:
Marketing Contact (if other than the person filling out this form.)
First Name:
Last Name:
Title:
Telephone: ext.
Email:
Business Information:
*Nature of business:
Top four products:


Services:
*Target Market/Industry focus:
*Year started business:
*No. of employees:
*Sales Revenue: 2003
*Sales Revenue: 2004
*Are you a Microsoft partner?	Yes No
If yes, what level?	Gold Certified Registered
Microsoft Competencies: (check all that apply)
Advanced Infrastructure
Information Worker
Integrated E-business
Learning Solutions
Microsoft Business Solutions
Networking Infrastructure
*Are you a Citrix Partner?	Yes No
If yes, what level?
Citrix Solution Advisor	Platinum Gold Silver
Citrix Alliance Partner (formerly CBA)	Platinum Premier Charter
Citrix Authorized Learning Center

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US toll-free: (800) 582-5167 Out of US: +1 (410) 715-4226