Alliances Qualifier

Qualifying Form for Resellers
Please provide the following information:

*Denotes required field

Company*

Name*

Title*

Phone Number*

Address*

City*

State/Province*

Country*

Zip/Post Code*

E-Mail Address*

Web site URL

Company Information

Type of Company - legal structure, ownership, officers or principals*


When was your company established?


What are your annual revenues?


Please provide an overview of your company and the services you provide*


Please describe your current growth strategy


Please provide a list of your current customers


How did you hear about HeartMath?


What is your interest in pursuing a partnership with HeartMath?*

Your personal information is not released outside of HeartMath.
For more information visit our Privacy Statement.