Pacom VAR Application

Pacom Systems designs, develops and manufactures integrated and networked security solutions for a range of single and multi-site applications. Pacom distributes its solutions worldwide through carefully selected Value Added system integrators. As part of the qualification process, we require all potential Resellers to submit this form. Please note that this is not a contract, and that there is no guarantee that your company will or will not be selected - we merely evaluate the potential of a partnership between our companies. Also please rest assured that all information is held in strict confidence.

Fields tagged with a red asterisk (*) are required. The submission process will reject any forms with blank values in these fields. If you wish, you may also print this page, fill it out and mail or fax to Pacom Systems.

Company Information

Name *

Company Name *

Pacom Sales Contact *

Company Headquarters' Address *

City/State *

ZIP/Postal Code *

Country *

Phone *

Fax *

Contacts

CEO/President *

E-Mail *

Sales Contact

E-Mail

Marketing Contact

E-Mail

Service Contact

E-Mail

Technical Contact

E-Mail

Primary Contact *

E-Mail *

Business Overview

Public Company    Privately held

Please list all national and international office locations and company headquarters.

Total sales last year (including product, installation and service revenue - please include unit of currency)

Total product sales revenue in the past 12 months (excluding installation and service revenue - please include unit of currency)

How many "new" systems has your company sold over the past 12 months?

Alarm Sites:
Access Control Systems:
CCTV Systems:
Other Types of System:	Explain:

Given your knowledge of Pacom Systems solutions, what would be your estimated forecast of new systems sales (i.e.: product purchased from Pacom Systems only) over the next:

12 months?
24 months?
36 months?

Markets Served

How many "new" systems has your company sold over the past 12 months?

Single-site installations:	% *
Campus-type installations:	% *
Multi-site Dialup installations:	% *
Multi-site WAN installations:	% *
Other:	% *   Describe:

Vertical Markets

Rank your focus towards each of the following types of end-user (1 being the predominate classification)

Financial	Gaming	Retail
Manufacturing	Transportation	Hospitality
Education	Healthcare	Government
Other - Please specify...

Describe your principal market

Describe your geographic territory focus:
Local          Statewide          Multi-state Region National      International

Countries

Cities

Check the Pacom Products of Interest

Alarm Monitoring

Integrated Systems

Access Control

Digital Video Storage/Transmission

Sales and Products

Please indicate the names of other Vendor programs you participate in

Other security hardware and software products sold *

Please mark all that apply:

Product Name / Model	Vendor	Market
None

Marketing Programs

Please mark all that apply:

	Self	Vendor	Please Specify
Newsletter or Email Update
Tradeshows
Seminars
Direct Mail
Advertising
	Other (describe)

Technical Support Capabilities

Please mark all that apply:

	No.	8x5	24x7	Region
Telephone Support *				Please select... Local Statewide Multi-State National Global
Advanced Replacement *				Please select... Local Statewide Multi-State National Global
Return/Repair Service *				Please select... Local Statewide Multi-State National Global
Software Upgrades *				Please select... Local Statewide Multi-State National Global
Outsourced *				Please select... Local Statewide Multi-State National Global
On-Site Support *				Please select... Local Statewide Multi-State National Global
Other (describe)

Sales and Support Organization

List the number of people in each role:

* Inside Sales	* Outside Sales
* System Engineers	* Technical Support
* Marketing	* Total number of employees

Please enter the characters from the security image to the right (in lowercase) *