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IPS Partner Program Registration Form
First Name:
Last Name:
Title/Position:
Company:
Company Web site:
Address:
Address:
City:
State:
Zip/Postal Code:
Phone Number:
Fax Number:
Email:

Comments:
Select from the following:

Publicly Held Company
Privately Held Company
   
Number of years in business?
Number of customers?
Annual sales?
 
Describe type of business:
What value can IPS provide to your company?
What value can your company provide to IPS?
Please provide a description of products and services you offer:
Average product cost?
What markets do you actively target?
Who are your competitors?
What other partnerships do you have?
Do you currently offer payment software? Yes     No
If "yes", please describe:
Comments: