Citrix Solutions Advisor Pre-Qualification Application

Membership Pre Approval

The information you provide in your CSA Pre Approval Application is very important. This information allows us to profile your company to better provide you with the tools you need to grow your business with us. Your profile will allow us to:

  • Determine your eligibility in the CSA program
  • Deliver your CSA benefits and information

Please provide all the information requested to ensure your application is processed promptly.

Certain items on this form are starred (*) to indicate that your answers will be kept CONFIDENTIAL.

Application to sell the following Citrix products. Mandatory Technical Support fees may be applicable depending on the CSA program in which you enroll.

Client Server Application Delivery (Citrix Access Suite or Presentation Server)
Web Application Delivery (Citrix NetScaler)
Access Security and Management (Citrix Access Gateway and Application Firewall)

Please return this completed application to Citrix Systems Asia Pacific Pty Ltd at:

Citrix Systems
Channel Operations Specialist
Suite 3201, 32nd Floor,
One International Finance Centre,
1 Harbour View Street,
Central, Hong Kong

For more information contact Channel Operations Specialist at +852 2100 5086 or email us at pacificchanneloperations@citrix.com

Company Profile
*Registered Business Name:  
ACN number (Australia Only)  
*Trading Name (If different to registered name):  
Contact Information
*First Name:  
*Last Name:  
*Title:  
*Email:  
*Phone Number:  
*Fax Number:  
Address Information (no PO Boxes please)
*Address:  
Address 2:  
*City:  
*State/Province:  
*Zip:  
*Country:  
What Citrix and Third Party products do you sell?
Example:

Vendor

Product Category

Product Range Sold

Number of Certified staff
(In that Product Range)

e.g. Citrix

Access Management

Presentation Server

2

       
Vendor
  		Product Category
  		Product Range Sold
  		Number of Certified staff
(In that Product Range)

Please enter the number of employees in your company:
Total Employees  
Sales employees  
Technical employees  
Other  
Please indicate your company's approximate annual revenue in US$: (CONFIDENTIAL)
  Less than $500,000
  $500,000 to $999,000
  $1,000,000 to $4,999,000
  $5,000,000 to $9,999,000
  $10,000,000 to $19,999,000
  $20,000,000 to $49,999,000
  $50,000,000 to $99,999,000
  $100,000,000 or more
Please indicate the percentage of revenue by category: (CONFIDENTIAL)
Desktop & Database Servers  
Vendor Developed Software  
In-house Developed Software  
Installation Configuration Services  
Maintenance & Support Services  
Networking Hardware  
Security & Integration  
Other  
What vertical market is your PRIMARY focus? (Indicate by percentage)
Finance / Insurance  
Logistics, Transportation, and Manufacturing  
Wholesale / retail  
Service/Travel/ Hospitality  
Telecommunications  
Education and Government  
Utilities  
What horizontal markets are your PRIMARY focuses? (Indicate by percentage) 
0 - 250 seats  
251 - 750 seats  
751 - 2000 seats  
2001 + seats  
   

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