First Name:
Last Name:
Job Title:
Company Name:
Address Line 1 :
Address Line 2 :
City:
State:
Zip:
Telephone:
Ext:
Cell Phone:
Fax:
Email:
Which of the following markets segments or technologies categories are of interest to your organization:
First Choice:
Select One
Small Market Mid Market Large/Enterprise Market Cloud Computing Managed Services Unified Communications System Integration Networking Security
Second Choice:
Select One
Small Market Mid Market Large/Enterprise Market Cloud Computing Managed Services Unified Communications System Integration Networking Security
Third Choice:
Select One
Small Market Mid Market Large/Enterprise Market Cloud Computing Managed Services Unified Communications System Integration Networking Security
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 ever attended a multi-day XChange event: (XChange Solution Provider, XChange, XChange Tech Innovator)
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 (1000 or more seats)
%
Please tell us which vertical markets you target:
Education
Federal
State/Local
Healthcare
Legal
Retail
Manufacturing
Real Estate
Insurance
Financial Services
Construction
Which of the following technologies do you provide?
Managed Services
Cloud Computing
Virtualization
Storage
Security
Storage
Custom Systems
Custom Software
VoIP
Networking
Application Hosting
Web Hosting
Unified Communications
Mobility
System Integration
Home Automation
Small Office/Home Office Integration
What are your entire firm's approximate gross annual sales? (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?
Hardware Sales:
%
Software Sales:
%
Services/Support Sales:
%
Which of the following vendors' products does your company resell?
3COM
Adtran
AMD
APC
BMC
Business Objects
Brocade
Cisco
Citrix
Cymphonix
CA
D-Link
Dell
EMC
Fortinet
HP
IBM
Intel
Lexmark
McAfee
Microsoft
Motorola
NEC Displays
Netgear
Nortel
Novell
Oracle
Panasonic
Red Hat
Sage
Samsung
SAP
Sonic Wall
Sony
Sprint
Symantec
Sun Microsystems
Toshiba
Trend Micro
Viewsonic
VMWare
WatchGuard
Websense
Other
Which of the following partner programs does your company participate in?
3COM
Adtran
AMD
APC
BMC
Business Objects
Brocade
Cisco
Citrix
Cymphonix
CA
D-Link
Dell
EMC
Fortinet
HP
IBM
Intel
Lexmark
McAfee
Microsoft
Motorola
NEC Displays
Netgear
Nortel
Novell
Oracle
Panasonic
Red Hat
Sage
Samsung
SAP
Sonic Wall
Sony
Sprint
Symantec
Sun Microsystems
Toshiba
Trend Micro
Viewsonic
VMWare
WatchGuard
Websense
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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