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Annual Revenue:
† Less than $5M
† $5M-20M
† $20-50M
Percentage of Sales:
Hardware
% Software
Services
%
For overall sales, what percentage is from printers,
media and printer service?
Your company is considered to be a:
† Distributor
† Hardware Dealer
† Value Added Reseller
† Solution Provider
† Other (please specify):
If you are a distributor, do you sell only to resellers?
If you are a reseller, do you sell only to end-user
customers?
SIGNATURES
Authorized Company Signature
Print Name
By submitting this application, you acknowledge your understanding and acceptance of the terms and conditions applicable to the 2009
"At your side" Partner Program. This agreement supersedes any other reseller or Brother programs unless specifically agreed to in writing.
Distributor Relationships (please mark all that apply):
† $50M-100M
† Ingram Micro
† $100M+
† Tech Data
† D&H Distributing
† ScanSource
† Other (please specify):
%
Your Vertical Market Focus Areas
(please mark the top 5 by sales revenue):
† Accounting
%
† Automotive
† Banking/Finance
† Software Developer
† Construction
† System Integrator
† Education
† Consultant
† Gov (Federal)
† Gov (State/Local)
† Healthcare
† Hospitality
† Insurance
† Legal
† Manufacturing
Application Software Packages That You Develop or
Integrate (please name the top 3 by sales revenue):
Authorized Brother Signature
Print Name
† BlueStar
† Synnex
† Azerty
† Horizon
† Mobility /
Field workforce
† Pharmacy
† Publishing
† Public Safety
† Real Estate
† Retail
† Route Accounting
† Security
† Telecom / Utility
† Transportation
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