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First Name:
Last Name:
Title:
Company:
Address:
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Zip (+4):
Country:	(if other than US/Canada)
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For audit validation purposes, on which day of the month were you born?

1. Primary Business Activity: (Check Only One)
VAR, Reseller, Dealer, Systems/Network/Software/Web Integrator, Telephony Reseller, VAR Consultant
Distributor/Wholesaler, OEM, Vendor/Manufacturer/Master VAR
Software Developer/ISV
ASP, AIP, Managed Host, Web Host, ISP, ISO, Managed Services Provider
Other (specify)

2. What Best Describes Your Title? (Check Only One)
President, Owner, Partner, V.P., Corporate Officer
General Manager, Manager Of: Branch, Division, Department
Sales Management/Staff
Technical Management/Staff
Other Management (specify)

3. Applications You Provide: (Check All That Apply)
AIDC/Supply Chain
Business Intelligence/KM
Card Technology / Biometrics
Customer Relationship Management
Document Imaging, Document Content & Management
Managed Services
Networking
Point of Sale (POS)
RFID
Security, Network
Security, Physical
Storage
Time and Attendance
VoIP / Telephony / Convergence
Wireless Networking / Mobile Computing

3A. Primary Application You Sell:

4. Vertical Markets You Sell To: (Check All That Apply)
Retail
Hospitality
Grocery/C-Store
Manufacturing/Warehouse
Wholesale/Distributing
Field Service/Route Accounting
Transportation
Real Estate
Utility
Healthcare/Life Services
Engineering
Government
Law / Public Safety
Insurance
Financial Services
Pharmaceutical
Education
SMB
General Office
Telecommunications

5. Software / Hardware You Supply: (Check All That Apply)
AIDC/SUPPLY CHAIN/RFID:
WMS
ERP
Bar Code Printers
Bar Code Scanners
Bar Code Media
RFID
Handheld Computers
Biometrics
ID Card Printers / Software
Access Control

POS:
POS Software
POS Peripherals (i.e. Printers, Displays, Drawers)
Touch Screens
Kiosks
Networking
POS Sytems
Electronic Cash Registers
Payment Processing
Video Surveillance
Gift/Loyalty Cards
Digital Signage

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

STORAGE:
Storage Software
Storage Virtualization
Disk-to-Disk Backup
Archival Storage (CD / DVD / MO)
Network Attached Storage
RAID
Storage Area Networks
Tape Backup
IP Storage/iSCSI

DOCUMENT MANAGEMENT:
Records Management Software
Document and Content Management Software
Document Scanning Software
Toolkits
OCR / ICR / Forms Processing
Workflow Software
Document Scanners
Copiers/MFPs
Check and Remittance Processing

6. Annual Sales In Dollars: (Check Only One)
50 million or more
20 million to 49.9 million
10 million to 19.9 million
5 million to 9.9 million
1 million to 4.9 million
under 1 million

7. What size organizations does your company sell to or service?: (Check All That Apply)
Fortune 1000
1000+ employees
100 - 999 employees
25 - 99 employees
1 - 25 employees

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