*Company name: Please no abbreviations or acronyms
*Address:
 
*City:
*State:    *Zip:
*Country:
*Phone number: Main Phone or Toll Free Number
*Fax Number: sample 999-123-4567
Company Web Address: www.yoursite.com
*Company E-mail address: yourname@yoursite.com
   
*Salutation: Mr. Ms. Dr.
*First Name :
*Last Name:
*Email:
*Title:
   
  What distributors do you purchase LCD products from?
(Select all that apply)
  Avnet Bell Micro BlueStar
  Compu-Data Ingram Micro (Nimax) ICG (Int'l Computer Graphics)
  Jaco Electronics Metropolitan Sales NSA Distribution
  ScanSource Synnex Tech Data
  Other
   
  Which of the following represents your job seniority?
  CEO/MD/Partner Consultant Director/VP/Senior Manager
  Staff Manager/Lead Other
   
  Which of the following customers does your business focus on?
(Select all that apply)
 

Small Business (companies with 1 - 99 employees)
Medium Enterprise (companies with 100 - 500 employees)
Enterprise (companies with 500+ employees)
Home & Home Office

   
  Which of the following represents your channel partner type?
  Value Added Reseller/VAR Systems Integrator Service Provider
  Distributor Direct Marketer / Mail Order Consultant
  OEM    
   
  What is your company size?
  less than 10 11-50 51-100
  101-500 Over 500  
   
  Which of the following LCD markets does your company provide solutions to?
(Select all that apply)
  POS POI KIOSK Medical
  Industrial Gaming Surveillance
  Public Display Transportation Other
   
  Which LCD products are of the most interest?
(Select all that apply)
  POS Touch Screens Medically Certified Displays Open Frame Non-Touch
  Open Frames with Touch Public Display/Digital Signage Panel Kits & Accessories
  Custom Design Solutions under 15” 15” to 19”
  20” and over    
   
Additional Comments:
   
   

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