About Acrendo

VAR Application

Value Added Reseller Application Form

Thank you for your interest in Acrendo Medical Software! Please fill out the Strategic Partner form below and submit it for review. A VAR manager will return your call to discuss your application further.

 

*Required Fields
Company Profile & Contacts
  
Company Name*
Primary Address*
City*
State*
Zip Code*
Phone Number*
Fax Number*
Email*
Website Address
Primary Contact
Name
Title
Phone
Email
Value of Partnership
Please give a brief description of what services your company provides:
Why is your company interested in creating a partnership with Acrendo
(Reseller, Referral Partner, IT Support, etc.)?
Who is your target market and customer base,
and what territories do you cover currently?
What are your current rates for any services you provide now?
IT References

If you have installed, supported or currently support a network and/or provided and installed hardware for an medical office client and you wish to be a client reference, please fill out this section. If not, please skip to the next section.

 

 Please provide us with 5 customer references of medical office clients you have worked with in the past 12 months.

1
Practice Name
Name of Lead Physician
Office Manager or Other Contacts
Phone
Email
When did you begin working with this client?

2
Practice Name
Name of Lead Physician
Office Manager or Other Contacts
Phone
Email
When did you begin working with this client?

3
Practice Name
Name of Lead Physician
Office Manager or Other Contacts
Phone
Email
When did you begin working with this client?

4
Practice Name
Name of Lead Physician
Office Manager or Other Contacts
Phone
Email
When did you begin working with this client?

 

 

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