Channel Partner

Preliminary Application Form

Please take your time to fill out this form using a desktop computer and ensure all details are correct before proceeding.

Company Name

Floor/Room Number

Street

City

State

Postcode

‎

Business Telephone

Fax Number

ABN

Years In Business

Website Address

Name

Title

Direct

Mobile

Email

‎

Name

Title

Direct

Mobile

Email

Business Nature

Value Proposition

‎Total Employees

Full Time

Part Time

Outsourced Resourcing

Sales

Full Time

Part Time

Outsourced Resourcing

Phone Sales

Full Time

Part Time

Outsourced Resourcing

Customer Service Staff

Full Time

Part Time

Outsourced Resourcing

Installation Staff

Full Time

Part Time

Outsourced Resourcing

Technical Support

Full Time

Part Time

Outsourced Resourcing

Management

Full Time

Part Time

Outsourced Resourcing

Other

Full Time

Part Time

Outsourced Resourcing

With regard to the outsourced resources (if any) briefly describe who is the outsourcer and what is their capacity

How many customers do you have today?

Actual revenue for last 12 months:

How many leads for new customers are you generating monthly?

Which Entrust ICT product offerings will be used?

Which competitor products are being sold?

Do you or shall you have the capacity to bill Broadband, Voice and Application services?

Yes No Other

If 'Other' please describe

From a marketing perspective which areas/territories do you target and who are your target market segments?

National

Regional Metro

NSW

Regional Metro

VIC

Regional Metro

QLD

Regional Metro

WA

Regional Metro

SA

Regional Metro

TAS

Regional Metro

NT

Regional Metro

What new market openings, vertical markets or significant increases in current market segments are you targeting?

Entrust ICT targets SME, Small Corporate and Enterprise customers, explain how you target these markets:

Additional Information

Credit Limit

Anticipated trading amount

3 account references (that you authorise us to call and undertake credit checks on your behalf):

Name

Title

Direct

Mobile

Name

Title

Direct

Mobile

Name

Title

Direct

Mobile

In the event that there is limited information or unsatisfactory credit history, will you be willing to supply a bank or director's guarantee?

Yes No

Channel Partner Preliminary Application Form