EGI

Company Information (all information will remain confidential)


Please note fields marked with an * are required.
* Company Name:
* Address 1:
Address 2:
* City:
* State/Province:
ZIP/Postal Code:
* Country:
* Telephone:
* Fax:
* URL:


Primary Contact Information


Please note fields marked with an * are required.
* First Name:
* Last Name:
* Job Title:
* Email:
Use the above company address? Yes
Address 1:
Address 2:
City:
State/Province:
ZIP/Postal Code:
Country:
Telephone:
Fax:

How did you hear about egi?

* Description of Product or Services

Please describe your product or services and how you feel they would align with the EGI product solutions.

* Target markets which you are interested in (Check all that apply):

Business Information (all information will remain confidential)

* Please describe your primary business:

Estimated Number of Employees:

Under 10 11 - 50 51 - 100 101 - 500 501+

Estimated Annual Revenue (million):

Under 10 11 - 50 51 - 100 101 - 500 501+

The geographic coverage of your company:

Local Regional National International

Percentage of Revenue from Services:
Percentage of Revenue from Software:
Percentage of Revenue from Hardware:

* EGI Products of Interest

Electronic Record Management System (ERM)	PerfectSuite™ Application Platforms
FastPath™	PerfectSuite™ Library

* Partner Program of Interest