Solution Provider Application Form

Full Name: *

Email: *

Coghead Member ID:

Phone Number: *

Company: *

URL: *

Address Line 1:

Address Line 2:

City:

State/Region:

Country: *

Postal Code:

What is the number of employees at your company?: *

How many customers do you currently have?: *

What does your company do?: *

Application Hosting

Custom Software Developer (Software Only)

Custom Solutions Provider (Hardware and Software)

Developer of Web Applications

General Business Consulting

IT Consulting Services

InternetServices/Solutions

Have your customers asked you to...: *

Deploy new applications to the web

Re-deploy existing client/server applications to the web

Eliminate server hardware and associated updating and maintenance

Allow employees, customers or partners access to applications with a web browser

When do you plan to have your first Coghead application ready?: *

Do you have customers waiting for your Coghead application to be ready?: *

Yes

To what size companies (number of employees) do you plan to sell your Coghead application(s)?: *

Coghead