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| •First Name: |
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| •Last Name: |
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| •Job Title: |
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| •Company Name: |
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| •Address Line 1 : |
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| Address Line 2 : |
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| •City: |
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| •State: |
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| •Zip: |
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| •Telephone: |
Ext:
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| •Cell Phone: |
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| •Email Address: |
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| •URL: |
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| •Is your company on the Solution Provider 500/VAR500 list this year or last year? |
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| •Please tell us which vertical markets you target: (Please hold down the Control key to select multiple answers) |
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| •Which of the following technologies do you provide? (Please hold down the Control key to select multiple answers) |
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•What are your entire firm's approximate gross annual sales?
(Example: $5.5 Million) |
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| •What percent of your total revenue is derived from each of the following? (Please note, total must add up to 100%) |
| Hardware Sales: |
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| Software Sales: |
% |
| Services/Support Sales: |
% |
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| •What is the number of employees in your entire organization (including all divisions, branches, and subsidiaries)? |
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| •What year was your company established? |
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| •What territory does your company cover? |
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| •What percent of your total revenue is derived from selling into the following markets? (Please note: must add up to 100%) |
| Small Market (0-100 seats): |
% |
| Mid Market (100-999 seats): |
% |
| Large/Enterprise Market (1,000 or more seats): |
% |
| •Which of the following Vendors does your company currently work with (please hold down control key to select multiple answers)? |
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| •Please identify your company's primary and secondary distribution partners. |
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| •What is the total value of Hardware, Software, and Services that you will purchase this year from distribution, manufacturers, other Solution Providers, or any other source as elements to the solutions you will deliver to your clients? |
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