CyberStateU.com Partner Form
CyberStateU.com Partner Application
Please fill in the following form as accurately as possible. Only completed forms will be reviewed.
Company Name:

Street Address:

Postal Code/Zip:

Phone Number:

Web Site Address:
 Division:

State/Region:

Country:

Fax Number:
Primary Contact:
First and Last Name

Phone Number:
 Title:

Email Address:

Company Description:


Product and/or Business Model Description:


Year Founded:

Geographic markets-Check all that apply:
 Are you currently an authorized reseller of:

Number of Employees:
Company:

Division:

Previous Year's Revenue:
Target Customers-Select all that apply:

Please describe how you will integrate CyberStateU.com's courses with your product/business model:


Are you interested in co-marketing opportunites with CyberStateU.com?
Yes No

Please indicate the CyberStateU.com partner level you are applying for: CyberStateU.com reserves the right to determine final partnership status.

By clicking the Submit button below, I indicate the desire of my company to participate in CyberStateU.com's Partner Programs and will use reasonable efforts to market, promote and sell CyberStateU.com products. CyberStateU.com reserves the right to update and change the requirements fo participation in any program upon thirty day notice. I also grant CyberStateU.com the right to refer to my company as a CyberStateU.com Partner in marketing literature, public announcements, and other marketing collateral. The completion of this form initiates the partnership process and is in no way a guarantee of acceptance into the CyberStateU.com partnership program.

Full Name: Title: