Contact Information

To access the partner site, please fill out this form completely.
( Indicates required fields) This page is only for U.S./Canada or OEM partners, all other partners should use this page.


First Name


Last Name


Title


Phone Number


Email Address


Fax Number


Type of Partnership
What is this?



Do you currently sell USRobotics products?
Yes
No


Company Name


Address(first line)


Address(second line)


City


State/Province


Zip/Postal Code


Country


What is your company's Web site address?


Which USRobotics products are you interested in?


OEM Only
If you selected "OEM" under "Type of Partnership" please answer the following question:

SAP Number (OEM Partner)


Broadband Only
If you selected "Broadband" under "Type of Partnership" please anwer the following questions:

Are you the decision maker for the purchase of DSL modems or routers and other end-user networking products provided by your company?
Yes
No

Are you interested in taking advantage of occasional USRobotics special "solution" bundles offered exclusively to our Broadband Partners?
Yes
No

Please rate your level of interest in the following networking/connectivity products:

Wireless Routers and Access Points Low Moderate High
Wireless/Wired Broadband Routers/Gateways (DSL/Cable) Low Moderate High
Broadband Modems (DSL) Low Moderate High
Ethernet Switches Low Moderate High
10/100 NIC Cards (PCI/PCMCIA) Low Moderate High
Analog Modems (External, Internal, or PCMCIA) Low Moderate High

VAR/E-Tail/Channel/Distributor Only
If you selected "Channel" under "Type of Partnership" please complete the following section:

Main Contact:
Name:
Phone:
Email:
Sales Contact:
Name:
Phone:
Email:
Technical Contact:
Name:
Phone:
Email:
Purchasing Contact:
Name:
Phone:
Email:

Who is your primary distributor?
Ingram Micro
Tech Data
D&H
Gates/Arrow
Synnex
Other, please specify:

What is your distribution account number?

Who is your distribution sales representative?

Please indicate what percentage of your business comes from the following (numbers should add up to 100%):
Small/Medium Business (SMB) SOHO
Large Enterprise (Corporate)
Systems Integration
System Builder (White Box OEM)

What markets do you serve?

Business Services
Communications
Financial
Healthcare
Hotel/Hospitality
Insurance
Legal
Management Services
Manufacturing
Real Estate
Retail/Wholesale

Are you a service provider?
Internet Service Provider (ISP)
Independent Telephone Company
Competitive Local Exchange Carrier (CLEC)
Independent Local Exchange Carrier (ILEC)
Independent Telephone Company

Do you sell to the Government?
Federal
State
Local

Do you sell to the Education market?
Higher Ed
K-12

Do you sell to the Consumer market?
Consumer (Home Networking)

How many employees in your company?
<9
10-19
20-99
100-999
1000+
Don't Know

Annual Revenue
<$1,000,000
$1,000,000-$2,499,000
$2,500,000-$4,999,000
$5,000,000-$10,000,000
$10,000,000 +
Don't Know

Please indicate your company's personnel in terms of the following:
Total Employees:
1-10
10-30
30+
don't know
Sales Reps:
1-5
6-10
11+
don't know
Full Time Technicians:
1-5
6-10
11+
don't know

What other Networking Solutions are you currently selling?
LinkSys
Belkin
SMC
D-Link
Efficient Networks/Siemens
3Com
Netgear
Netopia
Cisco
Microsoft
Other, please specify:

What certifications does your company have?
Microsoft
Cisco
Novell
Citrix
Compaq/HP
IBM
Intel
None
Other, please specify:

What 3 publications influence your network and connectivity solution decisions?

What web sites influence your network and connectivity solution decisions?

Of the trade shows you attended in the past year, which ones influenced your network and connectivity solution decisions?



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