Please provide your contact information:

First (Given) Name
Last (Sir) Name
Title
Company Name:
Work Phone
FAX
E-mail
Web Site

What partner type(s) are you applying for?

Administrative (fee: US$1,000)  Value-Added (fee: US$2,500)  Cooperative Marketing (fee: US$2,500)

Please describe your primary business:

What are the primary applications and industries targeted by your company?

Please list your key customers (company names):

What value do you see in partnering with BioComp?

What is the approximate number of employees in your company?

Under 10    10 - 50    50 - 100    100 - 500    500+

What is your company's estimated annual revenues (millions)?

Under 10    10 - 50    50 - 100    100 - 500    500 +

If your company is publicly traded, on what exchange and what is the ticker?

What resource types in your company would be involved in this partnership?

Sales and Marketing   Project Managers   Technical Consultants    Administrators

What geographic regions does your company serve?

Asia-Pacific   Europe         South America  Africa
Middle East    North America  Global         

What vendors do you currently have partnerships with or authorizations to market?

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