Please complete this form to apply as a DataStream Insurance partner. Call (408) 418-2178 if you have any questions. Thanks. Partner Application Step 1 of 3 33% Company* Name* First Last Title*(CEO, VP, Marketing Manager, etc.) Phone*Country*United StatesCanadaInternationalAddress* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email* Enter Email Confirm Email Website* HiddenYears in Business - DeprecatedDeprecated text field Years in BusinessHiddenBusiness Type Proprietor Partnership Corporation HiddenDistributorsWhich distributors do you purchase from (click all that apply) Ingram Micro Tech Data D & H Navarre GE Access SaaSMAX Douglas Stewart Lifeboat Other HiddenDistibution #Provide one distributor name and account # (used to verify reseller status)--or type NONE. ClassificationHow would you classify your company? (check all that apply) Select All MSP VAR System Integrator Consultant Distributor HiddenTotal # of clients - DeprecatedDeprecated text field Total # of clientsHiddenVerticalsSelect vertical markets you concentrate and specialize in (check all that apply)GovernmentEducationFortune 500AccountingAdvertisingAviationAutomotiveChemicalConstructionManaged ServicesDevelopmentEntertainmentFood ServicesHigh TechMedical Health CareInsuranceLibraryPublishingReal EstateSecurityTrainingTravelOtherDo you currently require your customers to have cyber insurance? What percentage of your customers do you estimate have cyber insurance?please select a percentage range below<10%10%-25%25%-50%50-75%90%+HiddenPrior Year Revenue - DeprecatedDeprecated text field Prior Year RevenueHiddenProjected Revenue - DeprecatedDeprecated text field HiddenProjected RevenueAnticipated revenues this year?Hidden% HardwareWhat % of your business Hardware?Please enter a number from 0 to 100.Hidden% Hardware - Deprecated% of your business is Hardware Hidden% SoftwareWhat % of your business is Software?Please enter a number from 0 to 100.Hidden% Software - Deprecated% of your business is Software Hidden% ServicesWhat % of your business is Services?Please enter a number from 0 to 100.Hidden% Services - DeprecatedPercentage business is Services HiddenGeography - DeprecatedWhat geographical area(s) do you serve (check all that apply) Replaced with single select field Local (50 mile) State Wide Regional (multiple states) National International GeographyWhat geographical area do you serve? Local (50 miles) Statewide Regional (multiple states) National International Total # EmployeesHidden# Inside SalesHidden# Outside SalesHidden# Engineers HiddenRelationships & CertificationsPlease list primary vendors you have a formal relationship with (reseller agreements). Include key certifications.Similar or Complimentary ProductsList other products you work with that are similar or complementary to DataStream products.HiddenValue Added ServicesProvide a description of your primary "Value Added" services (integration, training, custom development, consulting, etc.)Risk Assessment Tools & ProcessesWhat tools and/or processes do you currently use to do cyber risk assessments and measurement? If none, leave blank. Risk Assessment ExampleTo help us understand your process for analyzing client security, please upload any examples of a risk assessment that you are able to. Drop files here or Select files Max. file size: 50 MB. How did you hear about us?*Email from usNews StorySocial MediaTradeshow/EventAnother MSP referred youOtherIf referred by another MSP, please name.We want to give them credit for referring you! Reseller Agreement (please read) Click HERE to view the Partner Agreement (opens in its own window). Please email or call the Partner Manager if you have any questions. By submitting this form, I agree to the terms of the Partner Agreement.CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ