Targus PartnerVantage™ Program - Online Enrollment  CONTACT INFORMATION Company Name:* Job Title:* Department: Contact Salutation: Contact First Name:* Contact Last Name:* Contact Address:* Contact Address 2: Contact City:* Contact State:* Contact Zip/Postal Code:* Contact Country:* Contact Phone:* Extension: Contact Fax: Contact Email:* Company Web Site:* Head-Quarter Address:(if different from above contact address) Head-Quarter Address 2: Head-Quarter City: Head-Quarter State: Head-Quarter Zip/Postal Code: Head-Quarter Country:  COMPANY INFORMATION Statement: I HEREBY CERTIFY that I hold a valid seller's permit No. # issued pursuant to the Sales and Use Tax law; that I am engaged in the business of selling . Year Established: Number of Employees: 1-10 10-25 25-50 50-100 100-250 250-500 500-1000 1000+ Annual Sales Revenue: 250k – 500k 500k – 1m 1m – 5m 5m – 10m 10m – 20m 20m – 50m 50m – 100m 100 m + Monthly Notebook/white book/laptop Volume: 0-50 50-100 100-250 250-500 500-1000 1000-2500 2500+ Whose brands of note books do you resell? Mark all that apply. AppleCompaqDell HPIBM/LenovoPanasonic SonyToshibaWhite book Other, please list:     Business Type: Store-Front RetailerEcommerceIntegrator ConsultingManufacturerSystem Builder Other, please list:     Monthly System Volume: 0-50 50-100 100-250 250-500 500-1000 1000-2500 2500+ Distributors: ASID&HICG Ingram MicroSEDSynnex Tech Data Other, please list:     Vertical Market Specialty: Advertising/Design/PublishingCorporate EnterpriseEntertainment FinanceGov't - FederalGov't - Local Gov't - StateHigher EducationK-12 Education LegalMedicalReal Estate Small/Med. BusinessWhite Box/System Builder Other, please list:     Define you primary business. If more than one type applies, mark all that apply from 1-5, with 1 being the most business and 5 being the least business. System Builder - Primarily build notebooks and desktops for: N/A 1 2 3 4 5 SMB N/A 1 2 3 4 5 Fortune 1000 N/A 1 2 3 4 5 Government (Federal, State or Local), and Education N/A 1 2 3 4 5 Store Front (Sell to Consumer, SOHO and SMB) N/A 1 2 3 4 5 Other, please list:   VAR - Primarily sells branded notebooks and desktops to: N/A 1 2 3 4 5 SMB N/A 1 2 3 4 5 Fortune 1000 N/A 1 2 3 4 5 Government (Federal, State or Local), and Education N/A 1 2 3 4 5 Store Front (Sell to Consumer, SOHO and SMB) N/A 1 2 3 4 5 Other, please list:   Do you currently resell Targus Products? Cases Accessories Both No Targus Products Resold What other brands of mobile accessories do you resell? Notes (any further instructions, alternate address, etc.)