Become a PartnerPartner Application Step 1 of 333%Contact InformationDate* Date Format: MM slash DD slash YYYY Company Name*Name* First Last Job Title*Division/DepartmentAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Telephone*FaxEmail* Additional LocationsIf you operate out of multiple locations, please provide a separate listing of the addresses and contact information for those locations.CityStateZip Company InformationCompany Phone Number*Company Website* Principal Officer (CEO/President)* First Last Business InformationYears in BusinessHow many employees do you have in the following functions?Sales (outside/field-deployed)*Sales (inside/call-center-deployed)*Service*Marketing*Technical Support*Other*Total Number of EmployeesHow did you hear about our Partner Program?*Which products of Brother Mobile Solutions are you most interested in reselling?* PocketJet Printers RuggedJet Printers Mprint Printers PT-P900/950 TD-4000/4100 TD-2020/2120/2130Have you sold any of these products before?*YesNoWhich products have you sold before?Select all that apply (ctrl+click)PocketJet PrintersRuggedJet PrintersMprint PrintersPT-P900/950TD-4000/4100Do you have a customer wanting to purchase these products from you now?YesNoWhat products and quantities does your customer need?Use the plus (+) icon to add additional fieldsProductQuantity Are you responding to a bid for one of the above listed products?*YesNoWhich products are you responding to a bid for?Select all that apply (ctrl+click)PocketJet PrintersRuggedJet PrintersMprint PrintersPT-P900/950TD-4000/4100What do you expect your annual sales to be on any of the following products to be?PocketJet Printers*Please enter a number greater than or equal to 0.RuggedJet Printers*Please enter a number greater than or equal to 0.Mprint Printers*Please enter a number greater than or equal to 0.PT-P900/950*Please enter a number greater than or equal to 0.TD-4000/4100*Please enter a number greater than or equal to 0.Total SalesAnnual Revenue*Less than $5M$5M-20M$20M-50M$50M-100M$100M+Percentage of SalesHardware*Software*Services*Total PercentageMust equal 100%For overall sales, what percentage is from printers, media, and printer services?*Your company is considered to be a:*ConsultantDistributorHardware DealerSoftware DeveloperSolution ProviderSystem IntegratorValue Added ResellerIf you are a distributor, do you only sell to resellers?*YesNoIf you are a reseller, do you only sell to end-user customers?*YesNoDistributor Relationships*Please mark all that apply Azerty BlueStar D&H Distributing Horizon Ingram Micro ScanSource Synnex Tech Data Other NoneIf 'Other', please specify*Your Vertical Market Focus Areas*Please mark the top 5 by sales revenue Accounting Automotive Banking/Finance Construction Education Government (Federal) Government (State/Local) Healthcare Hospitality Insurance Legal Manufacturing Mobility/Field Workforce Pharmacy Publishing Public Safety Real Estate Retail Route Accounting Security Telecom/Utility TransportationApplication software packages that you develop or integratePlease name the top 3 by sales revenueSoftware PackagePercentage of Sales Revenue NameThis field is for validation purposes and should be left unchanged.ProductsSupportCompanyConnectSubscribe to our newsletter First Name * Last Name * Company Name * Email Address * State * -- Select State -- Alaska Alabama Arkansas Arizona California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Industry Vertical * -- Select Industry Vertical -- Field Services Field Services – Pest Management Healthcare – Clinical Healthcare – Home Public Safety Retail Route Accounting Transportation Multiple Verticals
