Application for Candidacy

All fields must be completed

Full and Complete Legal Company Name:

Mailing Address:

City:

State:

Zip Code:

Tel.#:

- -

Designated Sales Employee Name:

Title:

Direct Tel.#:

- -

E-mail Address:

Designated Technical Employee Name:

Title:

Direct Tel.#:

- -

E-mail Address:

Reseller Company Owner/President Name:

Direct Tel.#:

- -

E-mail Address:

Signature:

Date:

All questions must be completed in their entirety.

1. Currently purchase IP/networking products?	Yes No

2. If yes, which manufacturers and models?



3. Have purchased/currently purchase Panasonic i-Pro products?	Yes No

4. If yes, which models?



5. Percentage of analog vs. IP purchases?	Analog %IP %

6. Approx. total annual volume of IP sales?

7. Expected annual growth of IP purchases?

8. Number of salespeople?	Inside Outside

9. Of these, number of dedicated IP salespeople?

10. Do they have previous network certification?	Yes No

11. If yes, list Salesperson?s name, level of certification, and date of certification?



12. Number of technical people on staff?

13. Of these, number of dedicated IP technicians?

14. Do they have previous network certification?	Yes No

15. If yes, list Technician?s name, level of certification, and date of certification?



16. Which of these vertical markets have you sold IP products to? (Check all that apply)

Education Government Healthcare Corporate Financial Transportation Other