Business Name*
Address Line 1*
Address Line 2
City*
State or Province*
Country*
ZIP or Postal Code*
Web Site
Contact Information...
First Name*
Last Name*
Business Phone*
Title
Business Fax*
E-mail Address*
Business Profile...
Annual Sales Revenue*
Years in Business*
Federal Tax ID Number*
Vertical Market Focus
Number of Sales Representatives*
Number of Locations*
Describe your primary business focus: VAR, System Builder, Integrator, etc.*
Have you sold Ergotron products in the past?	No Yes
If yes, can you estimate your yearly sales?
Do You Sell...
Flat Panel Monitors?
If yes, please list brands of LCDs
Notebook Computers?
If yes, please list brands of notebooks
Large Screen Displays?
If yes, please list brands of plasmas and LCD TVs
Distribution Profile...
Who is your primary distribution partner?
Customer number for primary partner
Who is your secondary distribution partner?
Customer number for secondary partner
Other...
Is there anything else that you would like to add to help us evaluate your application?
How did you learn about Ergotron?*
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