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Vendor Application Form

Please complete the following vendor application form:

Company Information
* Company:
Website URL:
Address 1
Address 2
Address 3
Country
State/Province
City
Zip/Postal
Type of business entitiy:
How were you referred to us?:
* Number of employees:
* Year Established:
* Total Annual Revenue:
* Annual Revenue (Channel Products):
* Projected rev. this year (All Products):
* Proj. rev. this year (Channel Products):

Contact Information
Salutation:
* First Name:
* Last Name:
Title:
* Email:
* Phone:
Fax:
Mobile Phone:

Channel Information
Percentage of sales to End Users: %
* Percentage of sales to Resellers: %
* Percentage of sales to Distributors: %
Number of Resellers:
Number of Channel Resources:
Number of Field Sales Reps:
Number of Inside Sales Reps:
Number of Technicians/SEs:
Current Distributors:
Total number of units shipped annually (units sold and returns):

Product Information
* Select the Sub-Categories which best describe your products:
(check all that apply)
AIDC/POS
Business Software
Cabling
Components
Consumer Electronics
Consumer Software
Document Management
Gaming
Home Control
Mass Storage
Mobility
Networking
Network Storage
Presentations
Printers and Office Products
Security
Supplies and Accessories
Systems
Training and Services
Other
         
*Brief description of product/services:
*Average Product MSRP: $
Average product price to distributor: $
Average Distributor Margin: %
 
Reseller Certification Required:
Reseller Certification Offered:
Reseller Authorization required:
Reseller Authorization Offered:

Customer Information
Types of Indirect Customer/Channels sold into:
(check all that apply)
Direct Marketer 
VAR/Solution Provider 
Corporate Resellers
Service Providers/Telcos
Retail
Other
Types of vertical markets sold into:
(check all that apply)
Healthcare  
Financial  
SMB  
Government
Education 
Enterprise 
Other
 
Key Technical/Business Partners:
List your key resellers/customers:
Competitors:
Key competitive advantages:

Marketing Information
* What is your marketing budget for this Year? $
Demand Generation:
Targeted Reseller Market Segments:

Contact Info

RAD Media Corp
1725 Dolphin Ave.
Kelowna, BC, Canada
V1Y-8A6

Phone: 1.250.868.3555
Toll Free: 1.866.979.2774
Fax: 1.250.868.3557

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