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Company Contact Information
Company Legal Name
Application Contact
Office Mailing Address
Address Line 2
City
State
ALABAMA - AL
ALASKA - AK
ARIZONA - AZ
ARKANSAS - AR
CALIFORNIA - CA
COLORADO - CO
CONNECTICUT - CT
DELAWARE - DE
DISTRICT OF COLUMBIA - DC
FLORIDA - FL
GEORGIA - GA
HAWAII - HI
IDAHO - ID
ILLINOIS - IL
INDIANA - IN
IOWA - IA
KANSAS - KS
KENTUCKY - KY
LOUISIANA - LA
MAINE - ME
MARYLAND - MD
MASSACHUSETTS - MA
MICHIGAN - MI
MINNESOTA - MN
MISSISSIPPI - MS
MISSOURI - MO
MONTANA - MT
NEBRASKA - NE
NEVADA - NV
NEW HAMPSHIRE - NH
NEW JERSEY - NJ
NEW MEXICO - NM
NEW YORK - NY
NORTH CAROLINA - NC
NORTH DAKOTA - ND
OHIO - OH
OKLAHOMA - OK
OREGON - OR
PENNSYLVANIA - PA
RHODE ISLAND - RI
SOUTH CAROLINA - SC
SOUTH DAKOTA - SD
TENNESSEE - TN
TEXAS - TX
UTAH - UT
VERMONT - VT
VIRGIN ISLANDS - VI
VIRGINIA - VA
WASHINGTON - WA
WEST VIRGINIA - WV
WISCONSIN - WI
WYOMING - WY
Zip Code
Phone Number
Fax Number
E-Mail
URL
Company Classification
Years in Business
How would you classify your company?
(check all that apply)
Reseller
VAR
Systems Integrator
Consultant
Developer
Distributor
Other
List any vertical markets that you service
(comma separated list)
Prior year annual revenue
Projected revenue for this year
Percentage revenue
Hardware
%
Software
%
Services
%
What geographic area does your organization serve?
Local (50 mile radius)
National
Regional (300 mile radius/up to 5 states)
International
Total number of employees
Approximate number of employees that would sell and service
Full-time inside sales people
Outside sales people
Full-time pre-sales engineers
Post-sales engineers
Indicate what types of marketing activities your company engages in
(check all that apply)
Newsletters
Seminars
Trade Shows
Direct Mail
Print Advertising
Other
Please list software vendors, hardware vendors, consulting firms and/or systems integrators with whom your company has a formal business relationship. Include any existing certificates (i.e. Microsoft Solutions Provider Partner, Cisco Certified, Novel Platinum, etc.)
Please provide a description of value-added services that your company offers (i.e. reseller of software, network integration, custom development, training, installation)
Please provide a list of any products that you sell that might compete with MIE
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