ZixCorp Channel Partner Request Form

Thank you for your interest in becoming part of the ZixCorp Channel Partner Program.

Please take a moment to fill out the ZixCorp Channel Partner Request Form below in its entirety. Upon submission, the information will be reviewed by our channel team, and we will contact you for further partnership discussions.

Corporate Information

Company Name:* Address:* City:* State:* Select a State Alabama Alaska Alberta American Samoa Arizona Arkansas APO AA APO AE APO AP FPO AA FPO AE FPO AP British Columbia California Colorado Connecticut Delaware District Of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Island Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Other Zip/Postal Code:* Phone Number:* Company Web Site:

Geographic Area Covered: Primary States Covered: Other States Covered:

Vertical(s): Healthcare Government Finance Other:

Total Number of Employees: Total Number of Sales Representatives: Total Number of Technical Employees: Total Number of Marketing Employees:

Contact Information

First Name:* Last Name:* Title:* Direct Phone Number:* Cell Phone Number: E-mail:*

General Information

Which of the following services does your company currently offer? (Please check all that apply.) Hosted Email Anti-Virus/Anti-Spam Email Archiving Data Leak Prevention Email Encryption Data at Rest Encryption Other hosted service:

How would you describe your company’s primary business?* We deliver SAAS (Software-as-a-Service) solutions. We deliver SAAS and on-premise solutions. We provide network and hardware managed services only. We only offer on-premise solutions. Other:

Our typical customer is (please select one)* Select one 0-50 Users 51-99 Users 100-250 Users 251-500 Users 501-999 Users Over 1,000 users

Why are you looking to add ZixCorp’s email encryption services to your product line? State Laws Federal Laws/Mandates Our customers are asking for it, and we don’t have a solution. Other:

Why ZixCorp? (Check boxes with potential answers) Leader in email encryption market Customer Recommendation Referral Uniqueness of Technology Benefits of ZixCorp Channel Partner Program Reputation of ZixCorp Dissatisfied with current email encryption partner

*Required Fields