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KOM Networks - KOMunity Channel Application Form

KOMunity Channel Application Form

NOTE: Fields marked with a * are required.

Company Information

Company*
Address*
City*
State/Province
Zip/Postal Code*
Country*
Phone*
Fax
Web address

Primary Contact (Receives Starter Kit):
Name*		Title*
Phone and (ext.)*		Fax
Email*
How did you learn about KOM Networks Products:
Web Search Magazine Article Referral Advertisement
Other:

Business Information
How long have you been in business?
Type of Business?
Business Type:
Consultant	Developer	Distributor
OEM	Service Bureau	Systems Integrator
Trainer	VAR / Reseller	Other
If you selected "Consultant" or "Other", please provide details:

Geographic area your organization serves

US:	Northeast	Northwest	Midwest	Southeast	Southwest
International:	Canada		Latin America
	Asia Pacific		Europe
	Africa		Middle East

What overall percentage of your business is:
% Commercial	% Educational
% Federal Government	% State and Local Government


Estimate approximate annual revenue (US Dollars in Millions) for your organization:
$ Software Sales	$ Hardware Sales	$ Training
$ Service Bureau	$ Systems Integration	$ Other
$ Total

Please list total annual revenue for last two years (US Dollars in Millions):
$ Last Year	$ Two (2) years ago

Please list the number of employees per category:
Management	Tech Support	Sales
Consulting	Administration	Marketing
Sales Engineers	Training	Total

Of the number above, please list those employees per category dedicated to storage and content management:
Sales	Integration	Marketing
Technical Support	Sales Engineers

Target Markets

What vertical markets does your organization target? (check all that apply)

Accounting

Automotive

Communications

Education

Federal Government

Financial

Healthcare

Insurance

Legal

Manufacturing

Oil / Energy

Publishing

State / Local Government

Transportation

Utilities

Other(s)

Which of the following KOM Networks Solutions is your company interested in selling? (check all that apply)
KOMworx Complaince	OptiServer	OptiFile
KOMworx Enterprise
KOMworx Optistorm

Vendor Partnerships

What other vendor storage software are you authorized to sell? (check all that apply)
CA	EMC	HP	Legato
Pegasus	Tivolli	Veritas
Other(s):

What other vendor applications are you authorized to sell? (check all that apply)
Adobe	Cardiff	Documentum	Eastman
Filenet	Gauss	Hyland	IBM
IMR	Input	J.D. Edwards	Kofax
Lotus	Macromedia	Microsoft	Microsystems
NovaSoft	OpenText	Optika	Oracle
PeopleSoft	Saperion	Tower	TMS Sequoia
Other(s):

What other vendor hardware products are you authorized to sell?
ADIC	ASACA	DISC	EMC
HDS	Hitachi	HP	IBM
JVC	Kubota	LSI	Maxoptix
NSM	Panasonic	Pioneer	Plasmon
Ricoh	StorageTek	Sony	SUN
Other(s):

Which distributor(s) do you currently do business with:
Arrow Electronics	Access Graphics	Avnet	Bell Micro
Compucom	Cranel	GE Access	Ingram Micro
Merisel	New Wave	Optical Laser	Synnex
Tech Data	Trident Tek
Other(s)

Please list the top three distributors your company purchases storage and content management products from:
1.
2.
3.

What platforms do you sell and which are you certified to sell? (check all that apply)
HP OpenVMS	HP Tru64	HP-UX	IBM AIX
MacOS	Novell NetWare	SGI Irix	Sun Solaris
Windows 2000	Windows 2003	Windows NT	Windows XP
Other(s)

What databases and applications do you sell and which are you certified to sell? (check all that apply)
cc:Mail	DB2	Informix
Lotus Notes	MS Exchange	MS SQL Server
MySQL	Oracle	SAP
Sybase
Other(s)

Additional Contact Information

Primary Sales Contact
Name		Email
Phone	Ext.	Fax

Primary Technical Contact
Name		Email
Phone	Ext.	Fax

Primary Marketing Contact
Name		Email
Phone and (ext.)	Ext.	Fax

Primary Training Contact
Name		Email
Phone and (ext.)	Ext.	Fax

References

Please list one customer reference that is currently using your company's skills in providing storage and content management solutions:
Company		Contact
Address		Phone
City, State, Zip		Fax
Country

Security Code *

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