Partner Application Form Thank you for your interest in becoming a partner. We will review your application and reply back to you with additional questions if needed. Once you've reached the necessary certification levels for listing in the directory, your listing will be approved. Step 1 of 2 50% Name* First Last Organization*Country*AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Virgin IslandsBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaHong Kong, Special Administrative Region of ChinaMacao, Special Administrative Region of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao PDRLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedonia, Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint-BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint-Martin (French part)Saint Pierre and MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSuriname *Svalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab Republic (Syria)Taiwan, Republic of ChinaTajikistanTanzania *, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands, USWallis and Futuna IslandsWestern SaharaYemenZambiaZimbabweWebsite Skype ID*Email* Enter Email Confirm Email Type of Partner* Reseller Platform Solution Provider About Your OrganizationAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Size of the OrganizationWhat is your total number of staff?Annual RevenueWhat are the total annual revenues of your organization?What reseller services would you plan on offering?Implementation ServicesHosting and Support ServicesMifos Training & EducationLocalization & Custom DevelopmentSystems IntegrationReports DevelopmentMicrofinance & Biz Process ConsultingSocial Performance Mgmt ConsultingOtherWhich platform solution provider services would you offer?Product/Solution DevelopmentIntegration of existing productCustom app or module developmentAdditional InformationPlease list our your relevant experience:Describe relevant experience including previous and current work in the financial services, microfinance, or financial inclusion software or developing and implementing business and enterprise web applications.Team Description*Please describe the size and makeup of your team including their roles (sales, development, project management, etc), number of years of experience, skills/certifications, etc. Why are you interested in working in the financial inclusion sector?*What motivates you to support financial institutions working at the base of the pyramid? What are the opportunities being a Mifos partner will fulfill? What are your three year goals for working in this sector?What value will you bring to the community?*What are the unique services and offerings your team will bring to the Mifos community?Please describe your solution/productIf it's an existing product that you're integrating with or a new solution that you're developing. Include a link as well. What current customers are you working with?List out the current financial institutions you are working with (especially any of those that you're already working with Mifos on). How did you discover Mifos X?*Additional CommentsBackground Information Drop files here or Accepted file types: pdf, doc, docx, jpg, ppt, pptx, png. Please upload any background material (one pagers, fact sheets, brochures) about your organization or product. Please sign me up for the following: Mifos Newsletter (bi-monthly) Users Mailing List - discussion regarding deploying and using Mifos (moderate traffic) Developer Mailing List - technical discussion regarding development of Mifos (heavy traffic - 5 posts/day) EmailThis field is for validation purposes and should be left unchanged. Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.
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