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Your Company Name
Address1
Main Telephone
Main Fax
Select your Country choose from the following:AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe
City
Date of establishment
Branch Locations (if any )
Web Site URL
Which of the following categories best describes your company? Please SelectValue Added ResellerApplications / Systems IntegratorHardware / Software RetailerConsultantSoftware DeveloperOther
If your application is approved does ESC have your permission to reference this new relationship for PR purposes? YesNo
Key Management contact
GM phone Number
GM Email address
Key Sales contact
Sales phone Number
Sales Email address
Key Marketing contact
Marketing phone Number
Marketing Email address
Key Technical contact
Technical phone Number
Technical Email address
Preferred language contact with ESC EnglishFrenchArabic
Please List all your current Areas of interest / Technologies
Do you have current experience in Backup , Disaster Recovery ,Servers and Storage solutions (please specify brands if any)
Your current key Competencies and Specialist Skills (i.e.Sales and Technical Certifications)
List 5 of your top customers
List 5 of your top Prospects
Approximate Annual Revenue: less than $ 1 million$1million-$5 million$5million-$25 million$25million-$50 millionmore than $50 million
Total number of employees in your company: 10 or less11 to 5051 to 100101 to 500500 to 1000more than 1000
Does your company currently sell ESC products, or has it sold them in the past? yesno