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Accelerate Revenue
 
Partners
Specify your geographic market: *  (check all that apply)
 Americas    Europe     Asia    Global
 
Type of Partner: *

Application Service Providers (ASPs)
Complementary Solutions - BPO
Consulting and Integration
Platform Provider (software, hardware, or equipment)
Complementary Solutions - Health Services
Complementary Solutions - Software Engineering

 
Vertical Specialization:
Education Insurance
Healthcare Support Services State/Local Government
Healthcare IT Services Federal Government
Pharmaceutical Other:   
 
Company Information
Company Name: *
Salutation: * Mr. Mrs. Ms. Dr.
First Name: *
Last Name: *
Job Title: *
Address:
City:
State: * (Required only for Canada)
Country: *
Zip/Postal Code:
Telephone: *
Fax: *   
Email: *
Web Site URL: 

Company Description:
 
Please provide a brief overview of your company and the services you provide.
 
Date Established:
Held: Public     Private
Total number of Employees:
Annual Revenue (last year):
Where does your company generate its greatest revenue stream?

 
Partnership/Value Proposition and Business Opportunity
 
Please describe your company's key differentiators.
 
Why do you want to work with CureMD ?
 
What is your value proposition?
How would our potential partnership add value to the market/customers?
 
Are you currently partnering with any CureMD's competitors?
 
Is your proposition business opportunity-driven?
If so, please indicate the opportunity and approximate business potential ($).
 
Additional Comments: