Dealership Registration Contact Information: Please select the Partner Type you are applying for: DistributorInvestor Your Title:-- Select --MrMsMrs Your Email: Your First Name: Your Last Name: Telephone Number: Fax Number: Department:-- Select --AccountingAllianceExecutiveMarketingNot in the ListSales Technical Are you the business contact for the company? YesNo (If no, please add the business contact in the Key Contacts section below) Company Information: Company Legal Name: Country:-- Select --AlbaniaAlgeriaAngolaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBarbadosBelarusBelgiumBelizeBermudaBoliviaBonaireBosnia-HerzegovinaBotswanaBrazilBruneiBulgariaCanadaCayman IslandChileChinaColombiaCosta RicaCroatiaCuracaoCyprusCzech RepublicDemocratic Republic of CongoDenmarkDominican RepublicDubaiEcuadorEgyptEl SalvadorEritreaEstoniaEthiopiaFinlandFranceGeorgiaGermanyGreeceGuatemalaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKoreaLatviaLebanonLithuaniaLuxembourgMalawiMalaysiaMaltaMexicoMoroccoNamibiaNetherlandsNew ZealandNicaraguaNigeriaNorwayOmanPakistanPanamaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRepublic of MacedoniaRomaniaRussiaSaudi ArabiaScotlandSerbia And MontenegroSingaporeSlovakiaSloveniaSomaliaSouth AfricaSpainSri LankaSt. LuciaSt. MarteenSwedenSwitzerlandTadjikistanTaiwanTanzaniaThailandTrinidad and TobagoTunisiaTurkmenistanUAEUkraineUnited KingdomUruguayUSUzbekistanVenezuelaVietnamVirgin IslandYemenYugoslaviaZambia Street Address: City: State/Province: Zip/Post Code: Website: Organization: Organization Type:-- Select --CorporationS. CorpPartnershipSole Proprietor Date Founded: Annual Revenue:-- Select --1,000 to 10,000 $10,000 to 20,000 $20,000 to 50,000 $50,000 to 100,000 $100,000 to 500,000 $500,000 to 1 Million $1 Million $ Above Employees:-- Select --1-5051-100101-150151-200200 Above Please select a type:-- Select --Application DeveloperConsultantDistributorHardware MfctIntegratorResellerService ProviderSoftware DeveloperSolution Provider Geography & Industry : (select all applicable): Please select the geographic locations of your business: Geographic Organization Location-1: -- Select --AlbaniaAlgeriaAngolaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBarbadosBelarusBelgiumBelizeBermudaBoliviaBonaireBosnia-HerzegovinaBotswanaBrazilBruneiBulgariaCanadaCayman IslandChileChinaColombiaCosta RicaCroatiaCuracaoCyprusCzech RepublicDemocratic Republic of CongoDenmarkDominican RepublicDubaiEcuadorEgyptEl SalvadorEritreaEstoniaEthiopiaFinlandFranceGeorgiaGermanyGreeceGuatemalaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKoreaLatviaLebanonLithuaniaLuxembourgMalawiMalaysiaMaltaMexicoMoroccoNamibiaNetherlandsNew ZealandNicaraguaNigeriaNorwayOmanPakistanPanamaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRepublic of MacedoniaRomaniaRussiaSaudi ArabiaScotlandSerbia And MontenegroSingaporeSlovakiaSloveniaSomaliaSouth AfricaSpainSri LankaSt. LuciaSt. MarteenSwedenSwitzerlandTadjikistanTaiwanTanzaniaThailandTrinidad and TobagoTunisiaTurkmenistanUAEUkraineUnited KingdomUruguayUSUzbekistanVenezuelaVietnamVirgin IslandYemenYugoslaviaZambia Geographic Organization Location-2: -- Select --AlbaniaAlgeriaAngolaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBarbadosBelarusBelgiumBelizeBermudaBoliviaBonaireBosnia-HerzegovinaBotswanaBrazilBruneiBulgariaCanadaCayman IslandChileChinaColombiaCosta RicaCroatiaCuracaoCyprusCzech RepublicDemocratic Republic of CongoDenmarkDominican RepublicDubaiEcuadorEgyptEl SalvadorEritreaEstoniaEthiopiaFinlandFranceGeorgiaGermanyGreeceGuatemalaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKoreaLatviaLebanonLithuaniaLuxembourgMalawiMalaysiaMaltaMexicoMoroccoNamibiaNetherlandsNew ZealandNicaraguaNigeriaNorwayOmanPakistanPanamaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRepublic of MacedoniaRomaniaRussiaSaudi ArabiaScotlandSerbia And MontenegroSingaporeSlovakiaSloveniaSomaliaSouth AfricaSpainSri LankaSt. LuciaSt. MarteenSwedenSwitzerlandTadjikistanTaiwanTanzaniaThailandTrinidad and TobagoTunisiaTurkmenistanUAEUkraineUnited KingdomUruguayUSUzbekistanVenezuelaVietnamVirgin IslandYemenYugoslaviaZambia Geographic Organization Location-3: -- Select --AlbaniaAlgeriaAngolaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBarbadosBelarusBelgiumBelizeBermudaBoliviaBonaireBosnia-HerzegovinaBotswanaBrazilBruneiBulgariaCanadaCayman IslandChileChinaColombiaCosta RicaCroatiaCuracaoCyprusCzech RepublicDemocratic Republic of CongoDenmarkDominican RepublicDubaiEcuadorEgyptEl SalvadorEritreaEstoniaEthiopiaFinlandFranceGeorgiaGermanyGreeceGuatemalaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKoreaLatviaLebanonLithuaniaLuxembourgMalawiMalaysiaMaltaMexicoMoroccoNamibiaNetherlandsNew ZealandNicaraguaNigeriaNorwayOmanPakistanPanamaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRepublic of MacedoniaRomaniaRussiaSaudi ArabiaScotlandSerbia And MontenegroSingaporeSlovakiaSloveniaSomaliaSouth AfricaSpainSri LankaSt. LuciaSt. MarteenSwedenSwitzerlandTadjikistanTaiwanTanzaniaThailandTrinidad and TobagoTunisiaTurkmenistanUAEUkraineUnited KingdomUruguayUSUzbekistanVenezuelaVietnamVirgin IslandYemenYugoslaviaZambia Please select your main industry:-- Select --AerospaceAgricultureAutomotiveBankingBiotechnologyBroadcastCommercialCommunications/TelcoConstructionConsultingCorporateDigital SignageE-CommerceEducationEnergy and UtilitiesEngineeringEntertainment and MediaEnvironmentalFinanceGovernment - FederalGovernment - MilitaryGovernment - State/Local/ProvinceHealthcareHospitality and TourismHouse of WorshipInsuranceLawManufacturingNot For ProfitPharmaceuticalsPro AVReal EstateResearch and DevelopmentRestaurantRetailTechnology - HardwareTechnology - ServicesTechnology - SoftwareTransportationNot in this listNot Known Target Customers: (Provide Percentage total business in each target area): Branch/Remote Office:-- Select --< 5%6-10%11-25%26-50%51-75%> 75% Small Offices:-- Select --< 5%6-10%11-25%26-50%51-75%> 75% Medium Enterprise:-- Select --< 5%6-10%11-25%26-50%51-75%> 75% Midsized Offices:-- Select --< 5%6-10%11-25%26-50%51-75%> 75% Large Enterprise:-- Select --< 5%6-10%11-25%26-50%51-75%> 75% Description Of Your Business: Key Contacts Key Contact 1: First Name: Last Name: Email: Department: Key Contact 2: First Name: Last Name: Email: Department: Describe the value Delta Smart Innovation provides Your Company: Describe the value Your Company brings to Delta Smart Innovation: Describe the value of the partnership to your customer: