Full Legal Company Name:*

Business Address:*

City:*

Country:*

Zip:*

Main Phone Number:*

Does your company have a website?*

Web Site URL:

Number of store/office

locations:

Primary Distributor Contact name:

Title:*

First:*

Last:*

Telephone:*

Email:

Fax:

Purchasing Contact:

Title:

First:

Last:

Telephone:

Email:

Fax:

Sales Contact:

Title:

First:

Last:

Telephone:

Email:

Fax:

Marketing Contact:

Title:

First:

Last:

Telephone:

Email:

Fax:

Year your company was

established:*

Are you publicly held?*

Organization Structure (please check one)*

Name of Franchiser

Parent:

Total number of employees:*

Company's gross annual revenue:

For <%=DatePart("yyyy",Date())-1%>:

Anticipated <%=DatePart("yyyy",Date())%>:

Can your organization provide real-time inventory and sales-out data?*

Does the solution(s) you offer today have a hand-held component?*

% of your overall revenue generated from the

hand-held category

% of your total hand-held category sales generated from:

Hardware:

Software:

Services:

Q1:

Q2:

Q3:

Q4:

Please indicate what percentage of your revenue sales is derived from:

Large Business (over

100 employees):

Medium/Small

Business:

Federal Government:

State & Local

Government:

Education:

Consumer/Home

Office:

The total should equal 100%.

Does your organization provid customer and/or technical support?*

Do you have a dedicated customer service phone number?*

If yes, please specify

the #

Do you have a dedicated customer service email address?*

If yes, specify email

address:

Does your business resell products over the Internet?*

Does your company conduct internet auctions?*

What percentage of your gross revenue comes from Internet Sales?

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Anticipated <%=DatePart("yyyy",Date())%>

How many hits does your

Internet site receive in one

day?

What is your average

Internet order (in

dollars)?

Please list any other name your company goes by, and their URL addresses:

Company Name:

URL:

Company Name:

URL:

Company Name:

URL:

To gain a better understanding of your business we strongly encourage you to provide us with additional pertinent information about your organization.

First:*

Last:*

Title:*

Direct Phone Number:*

Email Address: