ProdexNet - Business Intelligence for the IT Infrastructure

Online Business Partners Application Form

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Company Information:

Company name/DBA:

Address 1:

Address 2:

City/State/Zip:

Main telephone number:

Main fax number:

Web address/URL:

Contact Information:

Primary Contact:

Title:

Address 1:

Address 2:

City/State/Zip:

Telephone number:

Fax number:

Email address:

President/CEO:

Telephone number/ext:

Chief Technology Officer/VP of Engineering:

Telephone number/ext:

Director/VP Sales:

Telephone number/ext:

Director/VP Marketing

Telephone number/ext:

Accounting Manager:

Telephone number/ext:

Person to whom ProdexNet
should send leads:

Telephone number/ext:

Company Profile/Data Sheet:

2000 Annual Revenues:

Number of field sales people:

Number of inside salespeople:

Number of tele-sales/marketing:

Number of engineers/consultants:

Total Employees:

List your top vendor/manufacturer authorisations:

Locations:

Total locations:

Addresses:

Core Competencies:

Please list your business practices/core business focus/geographic
markets serviced:

Vertical Focus:

Please list the top three (3) vertical markets/industries your company targets:

Service Provider	Legal	Healthcare
Retailers	Banking/Financial	Education
Transportation/Logistics	Insurance	Warehousing/Manufacturing
Government/Military	Farming/Agriculture	Utilities

Engineer/Consultant Certification:

Please list all industry certifications (CCIE, A+, etc.)
and the number of engineer certified in each:

Certification:	Number of Engineers:




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