Partner Application

[md-form]

[md-card title="Primary Contact"]
[md-text label="First name" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="Last name" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="Work Phone" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="Email" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="Job Title"] [/md-text]
[/md-card]

[md-card title="Primary Technical Contact (Optional)"]
[md-text label="First Name" tabletwidth="4" desktopwidth="6"] [/md-text]
[md-text label="Last Name" tabletwidth="4" desktopwidth="6"] [/md-text]
[md-text label="Work Phone" tabletwidth="4" desktopwidth="6"] [/md-text]
[md-text label="Email" tabletwidth="4" desktopwidth="6"] [/md-text]
[md-text label="Job Title"] [/md-text]
[/md-card]

[md-card title="Company Information"]
[md-text label="Company Name"] [/md-text]

Headquarter #1 Information:

[md-text label="Street" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="City" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-select label="State" tabletwidth="6" desktopwidth="6"] AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming [/md-select]
[md-text label="Zip" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-select label="Country" tabletwidth="6" desktopwidth="6"] -----United StatesCanadaMexicoUnited Kingdom-----AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArmeniaArubaAustraliaAustriaAzerbaijanAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet Island (Bouvetoya)BrazilBritish Indian Ocean Territory (Chagos Archipelago)British Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKazakhstanKenyaKiribatiKoreaKoreaKuwaitKyrgyz RepublicLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Netherlands)Slovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & S. Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe [/md-select]
[md-text label="Phone" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="Fax" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="Company Website" tabletwidth="6" desktopwidth="6"] [/md-text]

Headquarter #2 Information (Optional):

[md-text label="Street" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="City" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-select label="State" tabletwidth="6" desktopwidth="6"] AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming [/md-select]
[md-text label="Zip" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-select label="Country" tabletwidth="6" desktopwidth="6"] -----United StatesCanadaMexicoUnited Kingdom-----AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArmeniaArubaAustraliaAustriaAzerbaijanAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet Island (Bouvetoya)BrazilBritish Indian Ocean Territory (Chagos Archipelago)British Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKazakhstanKenyaKiribatiKoreaKoreaKuwaitKyrgyz RepublicLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Netherlands)Slovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & S. Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe [/md-select]
[md-text label="Phone" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="Fax" tabletwidth="6" desktopwidth="6"] [/md-text]
[md-text label="Company Website" tabletwidth="6" desktopwidth="6"] [/md-text]
[/md-card]

[md-card title="Company Profile"]

[md-textarea label="Company Description" tabletwidth="4" desktopwidth="6"] 2000Characters Remaining [/md-textarea]
[md-textarea label="Solutions and Products Currently Offered" tabletwidth="4" desktopwidth="6"] 2000Characters Remaining [/md-textarea]
[md-text label="Number of Years in Business" tabletwidth="4" desktopwidth="6"] [/md-text]
[md-text label="Industry Type" tabletwidth="4" desktopwidth="6"] 1000Characters Remaining [/md-text]
[md-select label="Company Size" tabletwidth="4" desktopwidth="6"] —Please choose an option—0-25 Employees26-50 Employees51-200 Employees201-500 Employees501-1,000 Employees1,001-5,000 Employees5,001-10,000 Employees10,001+ Employees [/md-select]
[md-select label="Annual Revenue" tabletwidth="4" desktopwidth="6"] —Please choose an option—< $1,000,000$1,000,000 - $10,000,000$10,000,000 - $25,000,000$25,000,000 - $50,000,000$50,000,000 - $100,000,000$100,000,000+ [/md-select]

[md-textarea label="Retail Clients" tabletwidth="4" desktopwidth="6"] 1000Characters Remaining [/md-textarea]
[md-textarea label="Geographic Markets Served" tabletwidth="4" desktopwidth="6"] 1000Characters Remaining [/md-textarea]
[md-textarea label="How did you hear about Indyme?" tabletwidth="4" desktopwidth="6"] 2000Characters Remaining [/md-textarea]
[md-textarea label="Description of Desired Partnership" tabletwidth="4" desktopwidth="6"] 2000Characters Remaining [/md-textarea]
[md-textarea label="Additional Comments"] 1000Characters Remaining [/md-textarea]
[/md-card]

[md-card title="Attach your Company Logo"]

[/md-card]

[/md-form]