Company Information: 
      Company Name: * 
      
      
      Street Address: * 
      
      City: * 
      
      State/Province: * 
      
      Zip/Postal Code: * 
      
      Region: * 
      --None-- APAC 
EMEA 
LAT 
NAM 
      Country: * 
      
--None-- 
 
      Website: * 
      
      Email Domain Used (domain associated to the partner account, ex: @company.com) * 
      
      Company Phone: * 
      
      Years in Business: * 
      
      
      Your Contact Information 
      First Name: * 
      
      Last Name: * 
      
      Business Email Address: * 
      
      Job Title: * 
      
      Contact Telephone: * 
      
      Business Function: * 
      --None-- Executive 
Marketing 
Sales 
Operations/Administration 
SE 
Professional Services 
Customer Support 
      Job Role: * 
      
--None-- 
 
      
      Are you the primary partner contact?
      --None-- Yes 
No 
      
      
          Primary Partner Contact  
          First Name: * 
          
          Last Name: * 
          
          Business Email Address: * 
          
          Job Title: * 
          
          Contact Telephone: * 
          
          Business Function: * 
          --None-- Executive 
Marketing 
Sales 
Operations/Administration 
SE 
Professional Services 
Customer Support 
          Job Role: * 
          
--None-- 
 
       
      
      Partner Signatory Contact 
      The same as above
      
      First Name: * 
      
      Last Name: * 
      
      Business Email Address: * 
      
      Job Title: * 
      
      Contact Telephone: * 
      
      Business Function: * 
      --None-- Executive 
Marketing 
Sales 
Operations/Administration 
SE 
Professional Services 
Customer Support 
      Job Role: * 
      
--None-- 
 
      
      Partner Marketing Contact 
      First Name: * 
      
      Last Name: * 
      
      Business Email Address: * 
      
      Job Title: * 
      
      Contact Telephone: * 
      
      Business Function: * 
      --None-- Executive 
Marketing 
Sales 
Operations/Administration 
SE 
Professional Services 
Customer Support 
      Job Role: * 
      
--None-- 
 
      Do you have a Silver Peak opportunity pending? * 
      --None-- Yes 
No 
      What were your total annual sales revenues last year?* 
      --None-- Below 500 thousand USD 
500 thousand to 1 million USD 
1 million to 5 million USD 
5 million to 10 million USD 
10 million to 50 million USD 
Above 50 million USD 
      Please indicate the number of employees in your organization:* 
      --None-- 1–5 
6-15 
16-25 
26-50 
51–100 
101–1,000 
1,001–5,000 
More than 5,000 
      Please indicate the number of sales personnel in your organization: * 
      - Outside Sales: * 
      
      - Inside Sales: * 
      
      - Sales Engineers (application/hardware): * 
      
      Please specify the TOP 3 industries you are re selling into: * 
      Banking 
Education 
Energy, Oil/Gas & Natural Resources 
Financial Securities 
Healthcare 
Insurance 
Manufacturing 
Media, Internet & Entertainment 
Software/IT enabled Services 
Pharmaceuticals 
Retail 
Telecomunications 
Transportation 
US Federal Government 
US Local Government 
Non-US Government 
Other 
 
Banking 
Education 
Energy, Oil/Gas & Natural Resources 
Financial Securities 
Healthcare 
Insurance 
Manufacturing 
Media, Internet & Entertainment 
Software/IT enabled Services 
Pharmaceuticals 
Retail 
Telecomunications 
Transportation 
US Federal Government 
US Local Government 
Non-US Government 
Other 
 
 
 
 
 
      Please specify what percentage of your business is: (total should be 100%) 
      - Product Sales: * 
      
      - Services Sales: * 
      
      - Consulting Sales: * 
      
      Do you provide your own brand of professional services? * 
      --None-- Yes 
No 
      Do you provide technical support? (choose all that apply) * 
      Telephone support 
Online support 
On-site engineers 
Not Applicable 
 
Telephone support 
Online support 
On-site engineers 
Not Applicable 
 
 
 
 
 
      What is your primary target market size? * 
      --None-- Very Small (1-99 employees) 
Small (100-999 employees) 
Mid Market (1000-50000 employees) 
Enterprise (above 50000 employees) 
      Please indicate your marketing offerings availability: (choose all that apply) * 
      Dedicated Marketing Resource 
Multi-touch Strategic Marketing 
Commitments to Marketing Funding 
Not Applicable 
 
Dedicated Marketing Resource 
Multi-touch Strategic Marketing 
Commitments to Marketing Funding 
Not Applicable 
 
 
 
 
 
      Please indicate if you are an authorized partner of one of the following: (choose all that apply) * 
      Aruba 
Cisco 
Citrix 
Dell/Ecologic/EMC 
Infoblox 
Microsoft 
Nutanix 
Riverbed 
VMWare 
Zscaler 
Not Applicable 
 
Aruba 
Cisco 
Citrix 
Dell/Ecologic/EMC 
Infoblox 
Microsoft 
Nutanix 
Riverbed 
VMWare 
Zscaler 
Not Applicable 
 
 
 
 
 
      Do you integrate cloud solutions with any of the vendors listed above?  * 
      --None-- Yes 
No 
      Of the vendors selected above, which do you integrate cloud solutions with? 
* 
      Aruba 
Cisco 
Citrix 
Dell/Ecologic/EMC 
Infoblox 
Microsoft 
Nutanix 
Riverbed 
VMWare 
Zscaler 
Not Applicable 
 
Aruba 
Cisco 
Citrix 
Dell/Ecologic/EMC 
Infoblox 
Microsoft 
Nutanix 
Riverbed 
VMWare 
Zscaler 
Not Applicable 
 
 
 
 
 
      Distributor of Choice: * 
      
      Tax ID Number: * 
      
      By submitting this application, the applicant is requesting Silver Peak's approval to procure Silver Peak products from a local Silver Peak authorized distributor.  The applicant acknowledges that Silver Peak may grant or withhold this approval in its sole discretion and, once granted, may terminate its approval for any reason upon thirty (30) days advance written notice.  Upon termination of Silver Peak's approval, the applicant will no longer be authorized to procure Silver Peak products and will immediately cease use of all Silver Peak material, including but not limited to Silver Peak products, marketing material and Silver Peak trademarks.