Company Name
Street Address
City
State
Zip
Country
Phone
Fax
Website (Optional)
Contact Person
Title
Ext. (if any)
Email
Type of Business
Company Brief
Total Annual Sales
% services
% software
% hardware
Total number of employees
Number of employees dedicated to sales
Number of employees dedicated to technical support
How many years your company has been in business
List all other Software / Automation hardware / software your company markets
List any related technology your company currently markets
Please provide us with two references, either vendors or customers, whom we can contact (Company name, relationship to your organization, contact name, phone #) (Optional)
What are the products that interest you the most?
Additional Comments (Optional)
