Program Application Questionnaire

To help us better understand your company, please complete and submit the following form:

Contact Information

*Indicates required field
First Name: *
Last Name: *
Title:
Company Name: *
Address 1:
Address 2:
City: *
State/Province: *
Country: *
Zip/Country Code:
Phone: *
Fax:
email: *
website:


Affiliation with IBM
      IBM Business Partner
Yes No
      IBM Premier Business Partner
Yes No
Company Information
      Number of offices
      Number of employees
      Geographic area covered:
      What is your company's area(s) of expertise?
      Does your company maintain a dedicated Lotus Domino IT staff?
Yes No
        If yes, how many?
      Does your company develop its own software products?
Yes No
      Does your company maintain a sales and marketing force in support of your products?
Yes No

If you have questions regarding Cobra Technologies, The Cobra Authorized Reseller Program, and/or our products and services, please contact:

Les Drane
Ldrane@cobratech.com
800.921.8189