Company Name:
First Name:
Last Name:
Job Title:
Address Line 1 :
Address Line 2 :
City:
State:
Zip:
Country:
Select One
Brazil
Guatemala
Argentina
Uruguay
Costa Rica
Mexico
Ecuador
Dominican Republic
Colombia
Panama
Belize
Venezuela
Puerto Rico
Peru
Paraguay
Chile
El Salvador
Nicaragua
Bolivia
Honduras
Guyana
Suriname
French Guiana
Haiti
United States
Canada
Telephone:
...
+55
+502
+54
+598
+506
+52
+593
+1
+57
+507
+501
+58
+1
+51
+595
+56
+503
+505
+591
+504
+592
+597
+594
+509
+1
+1
Ext:
Cell Phone:
Email:
Website:
Which of the following markets segments are of interest to your organization:
First Choice:
Select One
Small Market Mid Market Large/Enterprise Market Cloud Computing Managed Services System Integration Networking Security Healthcare Federal Government State/Local Government Education Custom Systems/Servers
Second Choice:
Select One
Small Market Mid Market Large/Enterprise Market Cloud Computing Managed Services System Integration Networking Security Healthcare Federal Government State/Local Government Education Custom Systems/Servers
Third Choice:
Select One
Small Market Mid Market Large/Enterprise Market Cloud Computing Managed Services System Integration Networking Security Healthcare Federal Government State/Local Government Education Custom Systems/Servers
To what degree are you responsible for building the vendor partnerships and alliances for your company?
Select One
Total Responsibility
Partial Responsibility
Minor Responsibility
No Responsibility
Have you attended a multi-day XChange event in 2008, 2009, or 2010 (XChange Solution Provider, XChange Public Sector, XChange (August), XChange Government Integrator, XChange Tech Innovators)?
Select One
Yes
No
What percent of your total revenue is derived from selling into the following markets? (Please note: must add up to 100%)
Small Market (0-100 seats)
%
Mid Market (100-999 seats)
%
Large/Enterprise Market (1,000 or more seats)
%
Please tell us which vertical markets you target: (To select multiple answers, please hold down the Ctrl key)
Education
Federal
State/Local
Private Healthcare
Public Healthcare
Legal
Retail
Manufacturing
Real Estate
Insurance
Financial Services
Construction
Which of the following technologies do you provide? (To select multiple answers, please hold down the Ctrl key)
Application Development
Backup and recovery
Build custom systems/servers/storage
Business applications (CRM and BI)
Cloud Computing
Consulting/Strategy/Professional Services
Contact Center/Call Center
Data Center-Cooling, Design
Data Protection
Develop Custom Software solutions
Digital Signage
Disaster Recovery/Business Continuity
Home Automation
Hosting/Application Hosting
Infrastructure Design and Implementation
Internet Services and Solutions
IT Consulting Services
Managed Print
Managed Services Provider
Mobility
Networking
Security
Small Office/Home office integration
Storage
Telecommunications
Unified Communications
Virtualization
VoIP integration services
What are your entire firm's approximate gross annual sales? (in US Dollars) (Example: $5.5 Million)
What is the number of employees in your entire organization (including all divisions, branches, and subsidiaries)?
Select One
5,000 or More
1,000-4,999
100-999
20-99
10-19
5-9
Less than 5
What year was your company established?
What territory does your company cover?
Select One
Local
Regional
National
Global
Do you sell proprietary software or hardware?
Select One
Yes
No
What percent of your total revenue is derived from each of the following? (Note: Must add up to 100%)
Hardware Sales:
%
Software Sales:
%
Services/Support Sales:
%
Which of the following vendors' products does your company resell? (To select multiple answers, please hold down the Ctrl key)
3COM
Acer
Adobe
Adtran
Alcatel-Lucent
AMD
APC
Apple
AT&T
Aten
Avaya
Barracuda
Belkin
BMC
Brocade
CA
Cisco
Citrix
Cymphonix
D-Link
Dell
Eaton/Powerware
EMC
Epson
Fortinet
Fujitsu Computer products
Gateway
Google
Hewlett Packard
Hitachi Data Systems
IBM
Intel
Juniper
Kaspersky
Lenovo
Level Platforms
Lexmark
McAfee
Microsoft
Motorola
NEC Displays
Netgear
Nortel
Novell
OKI Data
Oracle
Panasonic
Red Hat
Sage
Samsung
SAP
Seagate
Sonic Wall
Sony
Sprint
Symantec
Sun Microsystems
Toshiba
Trend Micro
Verizon
Viewsonic
VMWare
WatchGuard
Websense
Western Digital
Xerox
Other
Which of the following partner programs does your company participate in? (To select multiple answers, please hold down the Ctrl key)
3COM
Acer
Adobe
Adtran
Alcatel-Lucent
AMD
APC
Apple
AT&T
Aten
Avaya
Barracuda
Belkin
BMC
Brocade
CA
Cisco
Citrix
Cymphonix
D-Link
Dell
Eaton/Powerware
EMC
Epson
Fortinet
Fujitsu Computer products
Gateway
Google
Hewlett Packard
Hitachi Data Systems
IBM
Intel
Juniper
Kaspersky
Lenovo
Level Platforms
Lexmark
McAfee
Microsoft
Motorola
NEC Displays
Netgear
Nortel
Novell
OKI Data
Oracle
Panasonic
Red Hat
Sage
Samsung
SAP
Seagate
Sonic Wall
Sony
Sprint
Symantec
Sun Microsystems
Toshiba
Trend Micro
Verizon
Viewsonic
VMWare
WatchGuard
Websense
Western Digital
Xerox
Other
Please identify your company's primary and secondary distribution partners.
How do you expect your company's gross revenue (sales) to change during the next 12 months?
Select One
Increase Greatly (More than 15%)
Increase Moderately (Between 5% - 14%)
Remain the Same (Less than 5%)
Decrease Moderately (Between 5%-14%)
Decrease Greatly (More than 15%)
What is the total value of Hardware, Software, and Services that you will purchase this year from distribution, manufacturers, other Solution Providers, or any other source as elements to the solutions you will deliver to your clients?
Select One
Over $500 Million
$100-$499 Million
$50-$99 Million
$20-$49.9 Million
$10-$19.9 Million
$5-$9.9 Million
Under $2 Million
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