VIPGeek Corporation, Computer Repairs and Web Design Services

Thank you for your interest in VIPGeek

Working with VIPGeek will give you the opportunity to leverage your organization in the fastest growing segment of the Internet business today.

And working together as Partners, we can expand offerings and provide comprehensive, best-in-class solutions. If you would like to proceed with an application to our program, please complete the application that follows.

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All fields marked with an (*) must be completed in order for the form to be accepted.

VIPGeek Partnering Information:

* Specify your primary    geographic focus:

* Type of Partner:

Company and Contact Information:

* First Name:

* Last Name:

* Company:

* Job title:

* Address:

* City:

* State or Province:

* Zip or Postal Code:

* Country:

* Phone:

   Fax:

   Mobile:

* E-mail address:

* Web Site URL:

* Company Description:

* Why do you want to work    with VIPGeek?

* What is your value    proposition? How would    our potential partnership
   add value to the
   market/customers?

* Are you currently    partnering with any    VIPGeek competitors?

* Are you currently    partnering with, have    developed, or are currently    selling any complementary    or related solutions?

* What is the approximate    potential ($) of your    business proposition?

Sponsorship Information:

VIPGeek Sponsorship:
Please identify any VIPGeek representatives or Partners you are currently working with:

Customer Sponsor:
Please identify specific customers you are currently working with who have identified the need for a Hosting or Web project solution.

Customer Information:

   Company:

   Contact Name:

   Telephone:

   E-mail:

* Describe how your services are being used by the customer:

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