ACH Payment Solutions, MICR Check Printing, Document Management, EDI Software
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Partner Application Form

Items with an (*) must be completed for proper submission.
Full Legal Company Name:*
Address:*
City, State, Zip:*
Country:*
Web Site:*
Year Founded:*
Geographic Area Served:*
Number of Locations:*
Number of Employees:*
Annual Revenue:*
Number of Customers:*
     
Primary Partnership Contact:
      Name:*     
      Phone:*     
Email:*     
     
Primary Technical/Services Contact:
      Name:*     
      Phone:*     
      Email:*     
 

Please answer the following questions about your company and your objectives.

   
1. How would you classify your organization?*
  
2. Description of Primary Products/Services      Provided: Product Mix (Total =100%)
Software
Consulting
Hardware
Maintenance
Other Services
  
3. What platforms are supported?
  
4. Are you an IBM Business Partner?



  

5. Are you a Microsoft Solutions Provider?



  If Yes, what kind? - 
   
6. Which vertical markets do you specialize in?
   
7. Other software companies represented?
   
8. What is your expected level of activity?
   
9. Are you interested in imbedding, private     labeling, developing-on or OEMing ACOM     technology?



If yes, what is your potential interest? - 
   
10. Please describe the value added services      your organization would like to offer in      conjunction with ACOM's Solutions:
   
11. Comments
   




 



Document Management Software | Payment Management (MICR laser checks & electronic ACH payments) |EDI Software Solutions | Document Output Management

ACOM Solutions
2850 E. 29th Street · Long Beach, CA 90806-2313
Phone: (562) 424-7899 · Fax: (562) 424-8662
©2007 ACOM Solutions, Inc.