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/ Scorto™ Partner Application
Scorto™ Partner Application
Thank you for your interest in the Scorto™ Partner Program.
To apply, please provide us with the following information:
Company Name*:
Parent Company/Franchise of
Contact Name*:
Contact Job Title*:
Address*:
Town/City*:
State:
Zip Code:
Country*:
--Country--
United States
APO/FPO
Canada
United Kingdom
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan Republic
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde Islands
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Cote d Ivoire (Ivory Coast)
Croatia, Republic of
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Islas Malvinas)
Fiji
Finland
France
French Guiana
French Polynesia
Gabon Republic
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jersey
Jordan
Kazakhstan
Kenya Coast Republic
Kiribati
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts-Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Tahiti
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vatican City State
Vatican City State
Venezuela
Vietnam
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Western Samoa
Yemen
Yugoslavia
Zambia
Zimbabwe
Phone number*:
Fax number:
Web Address:
Email Address*:
When was your business founded?*
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
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1949
1950
1951
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1953
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1969
1970
1971
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1977
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1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Total number of employees?*
Total number of sales staff?*
What geographic area do you currently sell to and service in?*
What size company do you usually sell to?
Individuals
2-25
25-100
100-1000
1000+
Client references*
What are your main competitors?
Which industry/markets is your company active in?
Financial Services
Insurance
Banking
Telecommunications
Retail
Government
Other:
Your objectives for a partnership with Scorto™*:
Request Information
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Include any additional information regarding your request*