Partner Information

*All multiple choice fields are required

Partner company name:

ABN (if applicable):

Primary contact name:

Role/Title:

Email address:

Phone number:

Is this referral being submitted by a Sub-Partner? YesNo

If yes, please provide Sub-Partner name and contact details:

Prospect Information

Prospect company name:

Website:

Head office location:

Primary contact name:

Role/Title:

Email address:

Phone number:

Industry sector:

Estimated staff size: 1-2021-100101-500500+Unknown

Opportunity Details

Products / Services of Interest: Managed Services Agreement (Support & Subscription)Cybersecurity – Penetration TestingOther

Please specify:

Estimated Monthly or Project Value (if known):

Expected Timeframe to Proceed: 0-3 mo3-6 mo6+ mo

Current stage: Intro call heldDiscovery underwayAwaiting proposal

Relationship & Qualification

Is this Prospect a new, existing, or former Symsafe customer? NewExistingFormerUnsure

Are you directly engaging the decision-maker or an influencer? Decision-makerInfluencerOther

Has the Prospect indicated available budget or management support? YesNoUnsure

Are there any known competitors involved in this opportunity? YesNoUnknown

If yes, please specify:

Are there any potential conflicts of interest or sensitivities? YesNo

If yes, please explain:

Supporting Information

Brief opportunity summary:

Attach any supporting documents

Partner Declaration

I confirm that this referral is submitted in good faith, that the information provided is accurate to the best of my knowledge, and that I have the necessary authority to register this opportunity under the Symsafe Partner Referral Agreement.
Yes

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