FUNCTION
NAME
TITLE
EMAIL
PHONE
* Executive
* Marketing
* Support
* Sales
* Purchasing
Security/CCTV Systems Integrator
Security/CCTV Dealer/Installer
IT Systems Integrator
Security/CCTV Products Distributor
Other  
Airports
Banking/Finance
Casinos/Gaming
City Surveillance
Commercial
Data Centers
Education
Government
Healthcare
Manufacturing/Industrial
Retail
Sports/Leisure
Traffic Monitoring
Transportation
Utilities/Energy
Other 
I understand that in order to be a Qognify Authorized Channel Partner, the Company named in this application must purchase a minimum of $10,000 in Ocularis 5 products per year.