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Instant Video Presenter Partner Program

Partner Program Sign Up

Company Contact Information

Company Legal Name:

DBA:

Application Contact:

Office Mailing Address:

City:

State:

Zip:

Phone Number:

Fax Number:

E-Mail Address:

URL:

Shipping Address (if different)

City:

State:

Zip:

Accounting Contact:

Phone Number:

Purchasing Contact:

Phone Number:

Marketing Contact:

Phone Number:

Company Classification

Years in Business:

Business Type:

Which distributors do you typically purchase from:
Ingram Micro
Tech Data
D&H Distributing
GE Access
Navarre
Douglas Stewart
Other:

Please provide at least one distribution account number:

Distributor:

Account #:

How would you classify your company? (check all that apply)
Reseller
VAR
Systems Integrator
Consultant
Education
OEM
Developer
Chain
Franchise
Distributor
Mail Order
Other:

List any vertical markets that you service:

Prior year annual revenue
$

Projected revenue for this year:
$

Percentage revenue for

Hardware:

Software:

Services:

What geographic area does your organization server?
Local (50 mile radius)
Regional (300 mile radius/up to 5 states)
National
International

Total number of employees:

Apx. numer of employees that would sell and service:

Full-time inside sales people:
Full-time pre-sales engineers:
Outside sales people:
Post-sales engineers:

Indicate below what types of marketing activities your company engages in.
Seminars
Newsletters
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 list any relevant business relationships and alliances, including anyone you would partner with to solve your customer’s end-to-end solution:

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 ej4 :

The statements provided in this application are accurate to the best of my knowledge. I understand and agree to the following:

Completion and return of this application does not constitute acceptance by ej4 of the undersigned as a Reseller. ej4 reserves the right at its sole discretion to deny authorization for any reason. Failure to sign below will cause delay in application processing. All applications, approvals, and contracts must be complete before you may advertise or represent this location as an ej4 Reseller. Note that no binding agreement is formed until ej4 has approved you as a Reseller. ej4’s approval shall only be indicated by its written notification to you of acceptance.

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