• *Are you currently working with an NTI representative?
  YesNo
• *Representative name

• *Company
• *Street Address
• *City
  *State/Province
  *Zip/Postal Code
  *Country

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• *Phone
  *Website
• *Are you a subsidiary?
  YesNo
• *Parent Company Name
• *Parent Company Address

• *Name
  *Title
  *Email
  *Phone

Sales

• Name
  Title
  Email
  Phone

Technical

• Name
  Title
  Email
  Phone

Marketing

• Name
  Title
  Email
  Phone

Purchasing

• Name
  Title
  Email
  Phone

Support

• Name
  Title
  Email
  Phone

• *Number of Years in Business

Number of Employees

• *Total
  Inside Sales
  Outside Sales
  Technical Personnel

Annual Sales (in U.S. Dollars)

• *Last Year (USD)
  Current Year (USD)
  Forecast for Next Year (USD)

Breakdown of Revenue

• *Hardware %
  *Software %
  *Service %

Market Segment

• Business & Corporate %
  Government %
  Education %
  Healthcare %
  Worship/Religious Institutions %
  Digital Signage %
  Media/Entertainment %
  Telecommunications %
  Finance %
  Other %
  *List Other Market Segments

Service Area

• *Does your company sell locally, regionally or nationally? List the geographic areas you serve.

• How did you learn about Network Technologies Inc?
• *Annual NTI Purchases (estimated, in U.S. Dollars) if approved as international distributor

*NTI Product Interests

• Environment Monitoring Systems
  Video Matrix Switches
  KVM Switches
  KVM Splitters
  Multiviewers
  Video Walls
  Video Splitters
  Console Switches
  Extenders
  KVM Drawers
  Video Converters
  Video Switches
• *Do you agree to add the NTI logo/website link to your website within 30 days from the date approved as a international distributor?
  YesNo
• *List the other manufacturers' KVM and Audio/Video products you sell.
• List partner and distributor relationships (include vendor, program name, program level).
• *In general, why do you think your company would be a good international distributor of Network Technologies Inc's products?

• List Technical Certifications (include level and number of certified staff)
• *Will you be able to provide technical support to customers?
  YesNo
• What kind of technical training and how much do you require?