SMART Channel Partner Application

First Name

Last Name

Title

Role

Phone

Full Entity Corporate Name

State

Street Address

City

Postal/ZIP Code

Customer Segment

Website

States Serviced (optional)

Referring Distributor

Starin Marketing

I have reviewed and agree to the terms of the Authorization Agreement, including the indemnification and indemnity provisions set out therein. I acknowledge and agree that my affirmation constitutes a binding agreement between my organization and SMART Technologies.

I attest that I am authorized to enter into the Authorization Agreement on behalf of my organization.

Contact Information