First Name*
Last Name
Email Address*
Company*
Business Title*
Business Phone
Zip Code*
State*-- Please Select --AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutD.C.DelawareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVirgin IslandsVermontWashingtonWisconsinWest VirginiaWyoming
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Company Annual Revenue--Please Select--$20M+$10M - $20M$5M - $10M$2M - $5M< $2M
Estimated Revenue from SSD Sales in 2018--Please Select--$20M+$10M - $20M$5M - $10M$2M - $5M< $2M
What % of your annual revenue is from service?Whole Number Only
What % of your annual revenue is from product sales?Whole Number Only
Preferred/Primary Distributor--Please Select--ASIMa LabsD&HSynnexIngram MicroSelect All That Apply. Hold the CTRL key while selecting multiple options.
Primary Business Focus*--Please Select--Consumer SalesCorporate SalesIntegrator
How many technical solutions engineers / architects do you employ?--Please Select--01-56-1011-2021+
# of Outside Sales Employees.*
# Inside Sales Employees.*
Target Customer Size (employees)-- Please Select --0-99100-499500-9991000+
Company Website*
Geographic ReachNortheastSoutheastNorthern MidwestSouthern MidwestNorthwestSouthwestSelect all that apply
Vertical FocusCommunicationsConstructionEducationFinanceGovernmentHospitalityManufacturingProfessional ServicesRetailTransportation & LogisticsUtilitiesHealthcareOtherSelect all that apply
Services OfferedHosted or Cloud Servers On-Premise Servers Workstations High-End or Specialized Client PCs Low-End Client PCs Appliances / Embedded OtherSelect all that apply
Solutions FocusTrainingPre-Sales Support/QualificationPC/Server SecuritySystem IntegrationPost-Sales SupportOtherSelect all that apply
Full Name of Applicant
On behalf of my company, I am authorized to agree to these terms and conditionsViolating any of these conditions may result in immediate de-authorization
