Partner Application Form
Please fill out the necessary fields.
All Fields are Required.

Company Name
Company Phone / Fax
Business Address
Company Years in Business
Primary Contact Name, Title
Primary Contact Phone and Fax
Primary Contact Email Address
Company Website URL
Primary Business	Select Business Type Value-added Reseller System Integrator OEM
Regional Coverage	Select Regional Coverage State Country
Market Information
List the industry vertical segments served by your company-such as Automotive, Pharmaceutical, Food, etc.
RFID Systems / Auto-ID Experience (list top 1-3 vendors) such as Escort Memory Systems, etc	Years of experience or number of projects for each RFID / Auto-ID vendor
Number of RFID/Auto-ID projects per year
Average project size (total $)
Average RFID content per project ($)
Your Marketing Partners
Number of employees
Number of Technical Employees (engineering, technician, programmer)
Number of Sales Employees
Application Acknowledgment The information given is for the purpose of obtaining credit and is warranted to be true. We hereby authorize Escort Memory Systems to investigate the references listed pertaining to my / our credit and financial responsibility.
Title
Signature