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First Name:

Last Name:

Title:

Company:

Address:

Address 2:

City:

State:

Zip (+4):

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Please check here if this is an address change:

Country (if other than US/Canada):

Phone:

Fax:

E-mail Address:

For audit validation purposes, in what state were you born? (Province or Country if not in U.S.)

1. Primary Business Activity:

VAR, Reseller, Dealer, Systems/Network/Software/Web Integrator, Telephony Reseller, VAR Consultant
Distributor/Wholesaler, Vendor/Manufacturer/OEM, Master VAR
Software or Web Developer
ASP, AIP, Managed Host, Web Host, ISP, ISO
Other Allied to the Field

2. What Best Describes Your Title?

President, Owner, Partner, V.P., Corporate Officer
General Manager, Manager of Branch, Division, Dept.
Sales Management/Staff
Technical Management/Staff
Other IT Function

3. Applications You Sell Product, Equipment or Services In: (Check All That Apply)

4. Vertical Markets You Sell To: (Check All That Apply)

5. Software / Hardware You Supply: (Check All That Apply)

AIDC/SUPPLY CHAIN/RFID:

POS:

NETWORKING:

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LAN / WAN Hardware
Network Mgt Software
Wireless LAN / Wireless WAN
Network Security
Firewalls / VPN / Intrusion Detection / Anti-Virus
IP Telephony/VoIP/Convergence
Servers
Wireless Mobile Computing

STORAGE:

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Storage Mgt / SAN Software
CD / DVD / MO Jukeboxes
Fibre Channel
Network Attached Storage
RAID
Storage Area Networks
Tape
IP Storage
Disaster Recovery

DOCUMENT MANAGEMENT:

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COLD / ERM
Document Mgt Software
Document Scanning Software
Toolkits
OCR / ICR / Forms Processing
Workflow Software
Content Mgt Software
Document Scanners

6. Annual Sales In Dollars:

7. What size organizations does your company sell to or service?:

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Fortune 1000
1000+ employees
100 - 999 employees
25 - 99 employees
1 - 25 employees

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