Resellers

* Name

* Address:

* City:

* State:

* Zip Code:

* Country:

* Phone :

Fax:

* E-Mail:

URL:

* VAT/ Tin Number:

Year Established:

Last Year's Revenues:

* Please indicate the description that most accurately describes your company:

Select from list below VAD (value-added distributor) VAI (value-added integrator) Consulting Firm VAR (value-added reseller) ISV (independent software vendor) Retailer Other

If other:

* Please indicate the number of employees in your organization:

Select from list below 1-9 10-25 26-50 51-100 101+

Primary Contact

* Name:

* Job Title:

* Phone:

* E-Mail:

Sales Contact

Name:

Job Title:

Phone:

E-Mail:

Marketing Contact

Name:

Job Title:

Phone:

E-Mail:

Accounts Payable Contact

Name:

Job Title:

Phone:

E-Mail:

* Please indicate your primary target market:

Select from list below Small Organizations (11-100 users) Medium Organizations (100-1,000 users) Large Organizations (1,000+ users) Enterprise (5000+ users) State/Local Government Central Government SOHO (Small office/home office users) Educational Institutes

Please indicate the three vertical markets that your company primarily focuses on:
(e.g. Education, Healthcare, and Manufacturing)

Primary Vertical Focus:

Second Vertical Focus:

Third
Vertical Focus:

* Please indicate the regions your company sells into:

Please indicate what percentage of your revenue the following account for:

Hardware:

0-25%         25-50%         50-75%         75%+        

Software:

0-25%         25-50%         50-75%         75%+        

Services:

0-25%         25-50%         50-75%         75%+        

* Please indicate which storage brands you currently sell:

Other

Please indicate which products you are most interested in:
(check all that apply)

LIBRARY AUTOMATION:

Digital Library               CD/DVD Carousel      Ebook Reader    AMH/RIFID/Self Checkout systems

Databases

DATASTORAGE :

Network Attached Storage-NAS                    Direct Attached Storage (DAS Array, block level storage)-DAS

Storage Accessories Storage Area Network - SAN   SOFTWARE     Solid State Disk Drives - SSD

* Please indicate how you first learned of BCPL Storage:

Received Call from BCPL Sales Representative (Name):

Referral from (Company/Name):

Internet Search (Engine/Keyword):

I am a past or current customer:

Other:

Enter above Security Code here: