Reseller Order Form

Reseller Partner Order Form

Please complete the fields below and provide as much detail as possible. A detailed Statement of Work will be provided to the Submitter. This form is to only be completed by Reseller Partners for NEW orders. Please contact us directly for renewals or DFIR orders.
Reseller Information

Please complete the fields below for the RESELLER.
Full Company Name of Reseller*

Reseller Main Contact *

Rows	Please provide details:
Who will be our Main Contact?
Main Contact Title
Main Contact Email Address
Main Contact Phone Number

Organization

Please complete and provide details below for the END CUSTOMER.
Organization Name*

Technical Contact for Deployment *

Rows	Please provide details:
Full Name
Contact Email Address
Contact Phone Number
Contact Fax Number
Street Address
City
State
Zip Code

Total Number of Employees
Total Number of Endpoints
Total Number of Users
Total Number of Servers
Upload a Completed Cyber AssessmentPlace an Online Order
Please upload a copy of the Completed Cyber Assessment for this End Customer

Cancelof
Reseller Order Form (This is NOT an exhaustive list of products or services, please use the option above to "Upload a Completed Cyber Assessment" if you are seeking additional products or services for this end customer).
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Antigen Managed SOC
Per Endpoint

$35.00 Quantity



Avanan Protect (Base)
Per User

$36.00 Quantity



Avanan Advanced Protect
Per User

$45.00 Quantity



Avanan Complete Protect
Per User

$60.00 Quantity



DUO Security MFA (Base)
Per User

$34.50 Quantity



DUO Security Advantage
Per User

$69.00 Quantity



DUO Security Beyond
Per User

$104.00 Quantity



Red Canary MDR
Per Endpoint

$145.00 Quantity



SentinelOne Control 1YR
Per Endpoint

$50.00 Quantity



SentinelOne Complete 1YR
Per Endpoint

$55.00 Quantity



SentinelOne Complete + CloudFunnel
Per Endpoint

$60.00 Quantity



Tenable Vulnerability Management
Per Endpoint

$75.00 Quantity



Illumio Express EP
Per Endpoint

$75.00 Quantity



Illumio Express SRV
Per Server

$108.00 Quantity



Illumio Core
Per Server

$250.00 Quantity



CrowdStrike Falcon Complete
Per Endpoint

$100.00 Quantity



Orca Security
Per Workload

$100.00



Total

$0.00
YesNoUnsure
Please provide any additional information related to this order:
Our team will review your order form. If we have questions we will contact you at the phone / email provided below. Upon successful review we will provide a detailed Statement of Work.
Submitter Name*

First NameLast Name
Submitter Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Submitter Email*
example@example.com
PhoneEmailBoth
Date Submitted*

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty:

Reseller Partner Order Form

Reseller Information

Organization