CRU-DataPort™ Partner Application

Tell us about you: First name: * Last name: * Address: * City: * State: * Zip: * Title: * Phone Number: * email: * Web site Preferred method of communication: Phone Call Email

Tell us about your organization: Company name: * Describe your core business: * Consultant Value Added Reseller System Builder Solution Provider Etailer System Integrator Other     Number of sales people: *          Number of technical staff: *      Description

Select applicable vertical market(s) your organization sells to:* Enterprise Education State and local government SMB Forensics Federal Government Finance/Insurance Healthcare Digital Home/Audio-Video Mac Market Photography Pro AV Studios Other:

Preferred Distributors: Ingram Bell Micro D&H Synnex Other:

Federal Tax Number:

Security Box: What word appears in the security box to the left?

* Items marked with asterisks are required