Certified Consultant Program Enrollment Form

Thank you for your interest in becoming a Certified Consultant!

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Contact Information

Upon application approval, the following contact information will be used to list you as a Certified Consultant on our Web sites. Please make sure the information you list below includes data you would like shared with potential customers.

Business Name:

Doing Business As (DBA) Name:

Address:

Address 2:

City:

State/Province:

ZIP/Postal Code:

Country:

Primary Phone Number:

Ext.:

Primary Fax Number:

Web Site Address:

President/CEO/Owner/Executive Contact:

First Name, MI:

Last Name:

E-mail Address:

Sales/Marketing Contact:

First Name, MI:

Last Name:

E-mail Address:

Phone Number:

Ext.:

Fax Number:

Support/Customer Service Contact:

First Name, MI:

Last Name:

E-mail Address:

Phone Number:

Ext.:

Fax Number:

Business Type Information

Preferred Enrollment Level:

Business Focus: (Select all that apply)

Consultant
Development
Training
Vertical-Market Reseller

CPA Firm
Systems Integrator
Value-Added Reseller
Other

Business Type:

Number of Years in Business at This Location:

Number of Years Implementing Accounting Software at This Location:

Number of Locations:

Organizational
Number of Full-Time Employees:

Employee Make-up:

	Number of Employees:	Average Years of Experience:
Sales:
Consulting:
Development:

Annual Revenue:

Percentage of Overall Business:

% Application Development:		% System Integration:
% Consulting:		% Training:
% Hardware Sales:		% Other:
% Software Sales:

Client Profile:

Total Number of Clients/Customers:
Total Number of Accounting Installations:

Customer Focus:

Annual Revenue:

Type of Marketing: (Select all that apply)
Direct Mail	Seminars	Tele-marketing
Other
Marketing Activities Engaged in: (Select all that apply)
Advertising	Partnering	Referrals
Other

Products Currently Supporting:

Business Software: (Select all that apply)

Abra
ACT!
Best Enterprise Suite
Best Fixed Assets
Business Works
Carpe Diem
Computer Associates
DacEasy
MAS 90/MAS 200
MIP
MS/GP Dynamics
MS/GP Small Business Manager

MS/GP Solomon
MS/Navision
One-Write Plus
PC Law
Peachtree Accounting
QuickBooks
Sales Logix
Tabs
Time Matters
Timesheet Professional
Timeslips
Other

Vertical Application Software: (Select all that apply)

Associations
Construction
Discrete Manufacturing
Distribution
Government
Legal

Process Manufacturing
Property Management
Retail/POS
Service
Utility Billing
Other

Technical Expertise:

Number of Employees Experienced in NT:
Number of Employees Certified in NT:

References

Please include three companies using your business for onsite support:

Name: Phone:
Name: Phone:
Name: Phone: