Channel Partners

Please select the accreditation level

* indicates mandatory fields

* Trading Name :

* Address:

* Town:

* Company:

* Country:

* Post Code :

* Main Telephone :

* Primary Commercial Contact :

* Job Title:

* Email Address :

* Direct Phone :

* Primary Sales Contact :

* Job Title1:

* Email Address1 :

Direct Phone1 :

* Primary Technical Contact :

* Job Title2:

* Email Address2 :

* Direct Phone3:

* Primary Marketing Contact :

* Job Title3:

* Email Address3 :

* Annaul Turnover :

* Number of Employees :

Vertical Focus (if any) :

Technical Focus :

% of Business that is Thin Client :

Accreditions (e.g. Microsoft, Citrix) :

Accreditions Level Required :	Authorised Platinum

Print Name :

Position :

	I agree to abide by the terms of the VXL Partner Agreement.

Acceptance of Conditions:	I understand that the details I have submitted are to the best of my knowledge correct. I also understand that a sales person will contact me to discuss my requirement and submission of this form is in no way an acceptance of work to be undertaken,by VXL.