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ABOUT YOUR ORGANIZATION

Please provide the following company contact information and background as the first steps of your application to become a Mitel authorizedPARTNER.

The information you provide on your company in the following form is an important part of the qualification process and will be passed on to a Mitel Account Executive who will then determine your company's suitability for application to become a Mitel authorizedPARTNER. As a result of this decision if successful you will then be required to complete a full application.

* How did you hear about Mitel:

CONTACT INFORMATION
* Salutation: * Title:
* First Name: * Role:
* Last Name:
* Email:
* Office Phone Number :
Fax:

COMPANY INFORMATION
*
 Company's Complete Legal Name:

Primary Business Address:

* Country:
* Address:
* City:
* State / Province / County:
* Zip / Post Code:

* Website Address :

BUSINESS INFORMATION
*
 No. of years in business / Date Company Established


*
 What size of organization does your company typically sell to?
(Use CTRL key to select multiple)


*
 Total number of employees in your organization:


*
 Site location type for the above address (select all that apply)
Headquarters / Main Office
Admin only
Bill To / Invoice Address
Mail Only		Retail Outlet / Trade Desk
Sales Office
Service Centre
Ship To / Delivery Address		Warehouse
Affiliate Company - please provide affiliate name and web site address



*
 Do you currently sell used telecommunications equipment? Where do you purchase this equipment?



*
 Do you export equipment?



If you are currently working with a Mitel Account Executive, please provide their name:


If you are working with either a Mitel wholesaler or Mitel solution provider please name them


*
 Total Company Revenue for last Fiscal Year:
< 500K
500K to 1m
1m to 3m
3m to 5m		5m to 10m
10m to 20m
20m to 50m
> 50.0m

*
 Total Company Revenue Forecast for Current Fiscal year
< 500K
500K to 1m
1m to 3m
3m to 5m		5m to 10m
10m to 20m
20m to 50m
> 50.0m

*
 Select the Currency you report in:

*
Please confirm which suppliers' products you sell or support, stating the approximate percentage of sales the suppliers represent, your companies overall accreditation level and the products you are accredited to sell or support:
Voice Products
% of Revenue
Accreditation Level
Product names
Mitel Networks
3Com
Alcatel
Avaya
Cisco
Detewe
EADS
Ericsson
Intertel
LG Electronics
Nitsuko
Nortel
Panasonic
Philips
Samsung
Siemens
Toshiba
Others

Data Products
% of Revenue
Accreditation Level
Product names
Alcatel
3Com
Cisco
Foundry
Hewlett Packard
Nortel
Extreme Networks
Others

GENERAL COMMENTS

Mitel will process by computer (or otherwise) information requested on this form as a result of this enquiry. In addition, it may be necessary to pass the information provided onto Strategic Partners, Resellers & Distributors of Mitel in order to enable Mitel and / or its representatives to provide the information requested.

Additionally, Mitel would occasionally like to keep you informed about products and information which may be of interest to you, either by mail, telephone, fax or e-mail.

If you DO wish the personal data to be used for this particular purpose then tick the appropriate boxes:

all e-mail telephone fax post sms

If you DO NOT wish the personal data to be used for this purpose then tick this box


Note: All fields marked with an asterisk* are mandatory.