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Partnership Request Form
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Which type of partnership are you interested in?
* Partnership Type Referral Reseller Strategic Alliance
Tell us about yourself:
* Company Name
* Company Street
* Company City
* Website
* Contact Name
* Title
* Email Address
* Phone Number
* Province/State
* Country
Tell us about your company
* Primary Industry
* Number of Employees
* Size of Sales Force - Inside - Outside
* Number of Years in Business
* Region(s) of operation (select all that apply):
USA Canada Mexico UK EU Gulf States South America
Australia / New Zealand Other
* How many customers do you have worldwide?
Less than 100 101-500 501-1000 1001-5000 5001-10,000
* Average customer size (# of employees):
Less than 100 101-500 501-1000 1001-5000 5001-10,000 10,001-25,000
* What are your annual revenues?
Less than $1 million $1 million - $25 million $25 million - $50 million
$50 million - $100 million $100 million - $500 million $500 million - $1 billion
Above $1 billion I cannot provide this information
* Industries addressed:
Healthcare Professional Services Financial Services Manufacturing Education Public Sector
Hospitality Other - specify No specific target industry
* Identify the different products in your portfolio (select all that apply):
HRIS Software Payroll Software Recruiting Software Onboarding Software
Salary Content Competency Content Learning Management Content
EPM Consulting Career Planning Workforce Planning Metrics
Other
* What kind of services does your company provide?
* How would Halogen Software complement your portfolio?
* Do you have a current customer who's interested in purchasing a Halogen product right now?
Yes No
* Are you ready and willing to execute a Halogen Software mutual non-disclosure agreement?
Yes No

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