Contact Information
Salutation:
* First Name:
* Last Name:
* Title:
* Contact Phone Number:
Company Information
* Company Name:
* Address 1:
Address 2:
* City:
* Country:
----- Please Select -----
United States
Canada
Other
* State/Province:--Please Select Country First--
* Zip/Postal Code:
Public Phone Number:
Public Fax Number:
Public Email Address:
Company Website:
Federal Tax ID/GST:
State Resale Certificate/Permit:
* Number Of Employees:
* Number Of Office Locations:
* Company's Primary Business Model:
----- Please Select -----
Consultant Direct Market Reseller
Distributor
OEM
Retail
Managed Service Provider
Internet Service Provider
Systems Integrator
Value Added Reseller
Vertical Solutions Provider
* How did you hear about us?:
----- Please Select ----- Contacted By ZyXEL
CRN Magazine
Internet Search
Friend/Colleague
Trade Show
VAR Business Magazine
Spiceworks
ZyXEL Customer
Other
Vertical Industry Focus: (Hold ctrl while clicking to select one or more)
Accounting
Agriculture, Oil Exploration, Mining
Construction
Consulting
Distribution
Education
Electronics
Financial
Government
Healthcare
Hospitality
Insurance
Legal
Manufacturing
Media and Entertainment
Multi-Tenant Units (MxU/MTU)
Real Estate
Retail
Sales/Customer Relationship Management
Software
Telecommunications
Travel & Leisure
Utilities
Other
Product Interest: (Hold ctrl while clicking to select one or more)
DSL/Cable Broadband Access
Routing & Switching
Network Management
Network Security/VPN
Voice over IP
Wireless Networking
IP Camera
* End User Focus:(Hold ctrl while clicking to select one or more)
Home & Home Office
Small Business (1-99 Employees)
Medium Business (100-500 Employess)
Enterprise (>500 Employees)
* Annual Revenue Total:
----- Please Select ----- $0 - $100,000
$100,000 - $500,000
$500,000 - $1,000,000
$1,000,000 - $5,000,000
$5,000,000 +
* Annual Network Related Revenue:
----- Please Select ----- $0 - $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 +
Current Distribution Relationships: (min 1 required)
D&H Account Number:
D&H Canada Account Number:
Ingram Micro Account Number:
MBSI WAV Account Number:
Target Account Number:
Synnex Account Number:
Synnex CA Account Number:
WAV Account Number:
PACE Account Number:
User Name & Password
* Email Address:NOTE: your username will be your email address
* Password:
(must be 5 to 20 characters)
* Confirm Password:
* Verification