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Vendor Application
Company Information
*
Compay:
Legal Company Name:
Website URL:
Address 1:
Address 2:
City:
State/Province:
Zip:
Country:
State of Incorporation
Type of business entity:
Please Select
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?:
Fiscal Year-end (month)?:
Please select
January
February
March
April
May
June
July
August
September
October
November
December
%
*
Total Annual Revenue:
*
Annual Revenue (Channel Products):
*
Projected rev. this year (All Products):
*
Proj. rev. this year (Channel Products):
Contact Information
Salutation:
--None--
Mr.
Ms.
Mrs.
Dr.
Prof.
*
First Name:
*
Last Name:
Title:
*
Email:
*
Phone:
Fax:
Mobile Phone:
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:
(check all that apply)
AIDC/POS
Business Software
Cabling
Components
Consumer Electronics
Consumer Software
Document Management
Gaming
Home Control
Mass Storage
Mobility
Networking
Network Storage
Presentations
Printers and Office Products
Security
Supplies and Accessories
Systems
Training and Services
Other
*
Brief description of product/services
*
Average Product MSRP: $
Average product price to distributor: $
Average Distributor Margin:
%
Customer Information
Types of Indirect Customer/Channels sold into:
(check all that apply)
Direct Marketer
VAR/Solution Provider
Corporate Resellers
Service Providers/Telcos
Retail
Other
Types of vertical markets sold into:
(check all that apply)
Healthcare
Financial
SMB
Government
Education
Enterprise
Other:
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
