Asset Minder Pro Barcode Asset Tracking

To process this application simply fill out the following form, print it off and mail it to the address below. For quicker processing you can also submit this form via the submit button but the form must still be signed and sent by mail for proper validation.

1) Company Address Information:

Company Name:

Parent Company/Franchise of:

Street Address:

City:

State/Province:

Zip/Postal:

Country:

Telephone:

Extension:

Fax:

Electronic Mail:

Telex:

2) Reseller Permit Number (Please attach copy, must be included in order to process)

State/Province:

Number:

3) Please provide the following key contacts.

Principal Business Contact:

Title:

Principal Technical Contact:

Title:

President/Owner:

Sales/Marketing Manager:

Training Manager:

Support/Customer Service Manager:

PCI Official Use Only:

PCI Authorized Reseller Status Approved

Authorization Number: _________________	Date:_____________	By:_______________

SECTION B: BUSINESS INFORMATION

4) Which one of the following best describes your (primary) business?

Reseller
Consulting Service Provider
Systems Network Integrator
Software Developer
Vertical Applications Reseller
Original Equipment Manufacturer(OEM)
Government Systems Integrator
Other (please specify)

5) How long has your company been in business?

Less than one year
1 to 3 years
4 to 6 years
7 to 10 years
More than 10 years

6) Please provide the total number of company employees and the number of company employees who sell/support Network System Products and/or application software?

Company Employees
Company Employees who sell/support Network System Products.

7) Please indicate the revenue mix (totaling 100 percent) for your business (exclude parent company revenue).

% Hardware
% Software (purchased from vendors)
% Consulting
% Software (developed by your business)
% Technical Support
% Software development services
% Training

8) What is the anticipated number of PCI Product sold per year?

Asset Minder Pro Workstation
Asset Minder Pro Server
Asset Minder

9) Please indicate the size of company to which you primarily sell

Small (1-100 Employees)
Medium (100-1000 Employees)
F100
F500
Large (1000+ Employees)
F1000

10) Please indicate the number of desktops, PC Servers and minicomputers for which you have managed a solution project in the past year.

Desktops:
1 to 99
100 to 499
500 to 1999
More than 2000

PC Servers :
1 to 9
10 to 49
50 to 199
More than 200

Minicomputers :
1 to 9
10 to 49
50 to 199
More than 200

11) Do you sell custom applications?

YES NO
If yes, please identify type of application (i.e. database, office automation, accounting)

12) What types of technical support services does your business offer?

Installation
Product Demonstrations
Consulting Services
On-site repair and Maintenance
Technical Phone Support

13) If you provide training, which of the following types of training services do you offer
(check all that apply)?

Courses at your training facility
Custom training materials per installation
Video Training
Customer-site training
Network training
On-line training materials
Development/languages
Other (please specify)

SECTION C: PRODUCT INFORMATION

14) Please indicate the hardware platforms you currently sell and support (check all that apply)

Apple	IBM AS/400	AST
IBM RS/6000	AT&T	Intel PC
Acer/Altos	NCR	Compaq
NEC	DEC	Sun
Dell	Unisys	HP
Wyse	IBM PC

Other

15) Please indicate the operating systems and networking environments you currently sell
and support (check all that apply)

Apple A./UX	Microsoft Lan Manager
AT&T UNIX	Microsoft NT
Banyan	Microsoft Windows
DEC ULTRIX	Novell Netware
DOS	Sunsoft/ISC
HP/UX	Sun OS
IBM OS/2	Univel
IBM/AIX	Other

16) Please indicate the PCI products you plan to market. (check all that apply)

Asset Minder Pro Server
Asset Minder Pro Workstation
Asset Minder

SECTION D: INDUSTRY FOCUS

17) Please note your industry focus by ranking the top five client targets
(number 1 receiving the highest rank)

Accounting	Desktop publishing/graphic design
Aerospace	Distribution/whole sale
Architecture	Education
Automotive	Engineering
Banking	Federal Government
Biotechnology/scientific	Financial Services
Business	Hospitality
CAD/CAM/CAE	Image processing multimedia
Chemical/pharmaceutical	Insurance
Communications/electronic mail	Legal
Construction	Manufacturing
Medical/health care	Office automation
Radio/TV/entertainment	Real Estate
Retail/point of sale	Sales/marketing
State/local government	Transportatio
Utilities	Other

SECTION E: DISTRIBUTOR INFORMATION

18) Please list primary distributors from whom you currently purchase products
(attach additional sheet if necessary).

Distributor name	Your customer number
Distributor name	Your customer number
Distributor name	Your customer number

SECTION F: PCI PROGRAM REQUIREMENTS

To become a PCI Authorized Reseller you must satisfy the following sales and technical requirements via the options detailed below:

TRAINING COURSES AND OPTIONS REQUIRED FOR PCI RESELLER AUTHORIZATION:

Please specify when and where you, or a member of your staff, have taken the required PCI Reseller Sales Authorization training course and/or PCI Technical Requirement.

1) PCI Reseller Sales Authorization Course:

When

Training Facility

Attendee Name(s)

2) PCI Technical Requirement:

When

Training Facility

Attendee Name(s)

I hereby certify that the above information is true and complete to the best of my knowledge. If approved as a PCI Authorized Reseller, I agree to abide by the attached PCI Authorized Domestic Reseller Program Terms and Conditions and the requirements of the Reseller Program Level which I am awarded.

Signature:________________________________
Date:____________________________________
Name:___________________________________
Title:____________________________________

Thank you for your time in completing this application. All information will be treated confidentially. We look forward to working with you.

Return to the Var Opportunities
For more information on the PCI Authorized Reseller Program, contact PCI at:

12062 Valley View Street, Suite 208
Garden Grove, CA
92845
USA

206-1252 Lawrence Avenue East
Toronto, Ontario,
M3A 1C3
Canada

Tel. (416) 690-0440, Fax (416) 694-9172
email pci_info@pci-corp.com, Web: www.assetminderpro.com