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Company information
Company
*
Legal Company Name
Website
Address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Type of business entity
Sole proprietorship
Partnership
Corporation
LLC
How were you referred to MDC?
Is this a reseller specific request
If yes, please provide name
Public company stock symbol
Number of employees
*
Year established
*
Is your company currently or has it ever been party to a lawsuit with a customer?
Total Annual Revenue
*
Annual revenue (channel products)
*
Projected rev. this year (all products)
*
Proj. rev. this year (channel products)
*
Contact information
Salutation
*
Mr
Mrs
Ms
First name
*
Last Name
*
Title
Email
*
Phone
*
Fax
Mobile
Channel information
Percentage of sales to End Users (%)
*
Percentage of sales to Resellers (%)
*
Percentage of sales to Distributors
*
Number of Resellers
Will you be transitioning resellers to MDC
If yes, how many
Product Information
Select the Sub-Categories which best describe your products
AIDC/POS
Cabling
Consumer Electronics
Document Management
Home Control
Mobility
Network Storage
Printers and Office Products
Supplies and Accessories
Training and Services
Business Software
Components
Consumer Software
Gaming
Mass Storage
Networking
Presentations
Security
Systems
Other
Average Product MSRP ($)
*
Average product price to distributor ($)
Average Distributor Margin
Customer information
Types of Indirect Customer/Channels sold into
Direct Marketer
Corporate Resellers
Retail
VAR/Solution Provider
Service Providers/Telcos
Others
Types of vertical markets sold into
Healthcare
SMB
Education
Financial
Government
Enterprise
Others
Key Technical/Business Partners
List your key resellers/customers
Competitors
Key competitive advantages
Marketing information
What is your marketing budget for this Year? ($)
*
Demand Generation
Targeted Reseller Market Segments: Eg. IT Dealer, AV Channel or Mobile Dealer
Verification
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