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	Geographic Eligibility: USA, Canada

1.	*Do you wish to receive a FREE subscription to Business Solutions?*

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First Name:
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Job Title:
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Company Name:
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Address:
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What is the approximate number of employees in your company? (select only one)

Yes, please auto-fill my contact information for other publication qualification forms.

2.	For audit validation purposes, (since we cannot get your signature), What day of the month were you born?

3.	Primary Business Activity: (select 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 Service Provider

Other (please specify)

4.	What best describes your title? (select only one)

President, Owner, Partner, V.P., Corporate Officer Technical Management/Staff

General Manager, Manager Of: Branch, Division, Department Other Management (please specify)

Sales Management/Staff

5.	Applications You Provide: (select all that apply)

C. AIDC/Supply Chain G. RFID

M. Business Intelligence/KM F. Security, Network

K. Card Technology/Biometrics J. Security, Physical

R. Customer Relationship Management H. Storage

E. Document Imaging/Content Management D. Time & Attendance

I. Managed Services Q. VoIP/Telephony/Convergence

B. Networking O. Wireless Networking/Mobile Computing

A. Point of Sale (POS)

5a.

Primary Application You Sell:

6.	Vertical Markets You Sell To: (select all that apply)

Retail Government

Hospitality Law/Public Safety

Grocery/C-Store Insurance

Manufacturing/Warehouse Financial Services

Wholesale/Distribution Pharmaceutical

Field Service/Route Accounting Education

Transportation Telecommunications

Utility Real Estate

Healthcare/Life Sciences SMB

Engineering General Office

7.	Software/Hardware You Supply: (select all that apply)

AIDC/Supply Chain/RFID

WMS RFID

ERP Handheld Computers

Bar Code Printers Biometrics

Bar Code Scanners I.D. Card Printers/Software

Bar Code Media Access Control

POS

POS Software POS Systems

POS Peripherals (i.e. Printers, Displays, Drawers) Electronic Cash Registers

Touch Screens Payment Processing

Kiosks Video Surveillance

Networking Gift/Loyalty Cards

Digital Signage

Networking/Wireless

LAN/WAN Hardware Firewalls/VPNs/Intrusion Detection/Anti-Virus

Network Mgt Software VoIP/IP Telephony/Convergence

Wireless LAN/Wireless WAN Servers

Network Security Wireless Mobile Computing

Video Surveillance UPS

Storage

Storage Software RAID

Storage Virtualization Storage Area Networks

Disk-to-Disk Backup Tape Backup

Archival Storage (CD/DVD/MO) IP Storage/iSCSI

Network Attached Storage

Document Management

Records Management Software Workflow Software

Document & Content Mgmt Software Document Scanners

Document Scanning Software Copiers/MFPs

Toolkits Check and Remittance Processing

OCR/ICR/Forms Processing

8.	Annual Sales In Dollars: (select only one)

$50 million or more $5 million - $9.9 million

$20 million - $49.9 million $1 million - $4.9 million

$10 million - $19.9 million Under $1 million

9.	What size organizations does your company sell to or service? (select all that apply)

Fortune 1000 25 - 99 employees

1000+ employees 1 - 24 employees

100 - 999 employees

10.

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