Please enable JavaScript in your browser to complete this form.VAR Contact InformationPrimary VAR Contact Name *FirstLastPrimary VAR Contact PhonePrimary VAR Contact EmailPrimary VAR Contact Birth Day/Month OnlyIs there a Secondary VAR ContactYesNoSecondary VAR Contact NameFirstLastSecondary VAR Contact PhoneSecondary VAR Contact EmailSecondary VAR Contact Birth Day/Month OnlyVAR Company InformationVAR Company NameVAR Company Location(s)ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMAMDMEMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYPlease select each state if multiple locations.VAR DBA NameDoes VAR Sub Contract?YesNo Focus Agents of VAR HQ AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIs VAR a Distributor?YesNoIs the VAR a Distributor of hardware or software? Is the VAR Publicly Traded?YesNoStock SymbolGovernment or Public Sector ContractsYesNoDoes the VAR currently have any Government or Public Sector contracts?Details of Gov or Public Sector ContractType in any Govt or Public Sector contract details that apply (GSA, NASPO, etc)VAR Company WebsiteUS Small Business Admin CertificationSmall Disadvantage Business (8a)Economically Disadvantage Women OwnedHistorically Underutilized Business Zones (HUBZone)Minority OwnedSmall BusinessService Disabled Veteran OwnedSelect all the values that has a US Small Business Admin Certification. VAR DUNS Number *VAR Number of EmployeesHow many full time employees does the Partner Account have?VAR No of Sales AgentsHow many employees will be engaged in sales activities?Competitor 1 Company NameProvide the first of your top three competitorsCompetitor 2 Company NameProvide the second of your top three competitorsCompetitor 3 Company NameProvide the third of your top three competitorsVAR Customer FocusVAR Sales TerritoryNationalRegionalVAR Customer MarketsAllEastSouthWestVAR Customer SegmentsAllSmall/MediumLarge/EnterpriseNationalState/LocalEducationFederalVAR Selling Model--- Select Choice ---DirectRetailTelesalesVAR OfferingsVAR Solutions4G LTE Business Internet5G Business InternetAsset Tagging - ManagementBandwidth ManagementBusiness Continuity - FailoverCloudDevice Management - MDM EMMDigital Signagee-FaxingInformation Technology - ITInternet Of Things - IoTKitting and StagingPERS - Panic ButtonPoint Of SalePortable Voice / Data NetworkPOTS Line ReplacementProfessional ServicesRadio Frequency In-Building - CampusRouter Sales/SupportSaaSSecurity SaaSSmart CitiesSurveillanceTelehealthTelemetryVoIPConnected LaptopsOther SolutionVAR Hardware TypeCameraGPS TrackerOne TalkRugged HandheldRugged LaptopTabletsDronesSensorsSmartphone - AndroidSmartphone - iOSEmbedded 4G/5G Router - ModemNon Rugged TabletWearables / Watch / AccessoryOther Embedded 4G/5G DeviceOtherBusiness PlanDefine Business PlanDefine your business plan to meet your committed sales objectives.Outline Marketing Plan To PromoteDefine how you are going to market / position your solutions to meet your committed sales objectives.Est. 12 Month 4G/5G Connection ForecastProvide 12 to 24 month revenue forecast, e.g. 4G Connections or other Verizon related revenueVAR Vertical SpecialtiesVAR VerticalsEnergy and UtilitiesManufacturingFinance and InsuranceRetail and HospitalityHealthcareTransportation & DistributionPro Services, Technology, MediaGovernment or EducationPlease select all that pertain to youVAR OEM RelationshipsOEM RelationshipsAdtranAppleCradlepointCiscoHPDigiLGGoogle AndroidMicrosoftHoneywellPeplinkLenovoSamsungPanasonicVMWareSierra WirelessInHandPlease select all that pertain to youSubmit
