Reseller Pre-Qualification Form
Company Name:
Parent Company
(if applicable):
Address:
City:
State:
Zip:
Your Name:
Your Title:
Phone Number:
Fax Number:
Email address:
Company Web Site:
Company Email:
   
How many employees are in your organization?
Current Acena Representative you are speaking with (if any):
 
Business Background
Description:
If incorporated, please list states where incorporated:
What is the principal activity of your business?
   
Please check where you do business:
  Domestic
Northeast
Mid-Atlantic
Southeast
Midwest
Southwest
Northwest
West
  International
Canada
Central/South America
Asia Pacific
Western Europe
Eastern Europe
Middle East
Africa
   
What type of products or services does your company sell?
How many current customers (unique companies) does your business have?
What percentage of your customer base is applicable for selling Acena products and services?
Typical Customer Business Type:
 
Business Plan
How many new customers does your business anticipate acquiring this year?
Monthly:
Annually:
Typical New Customer Business Type:
 
How many of the following services do you think your business would be able to sell in the next 12 months? (Leave blank if you do not expect to sell any.)
   
Product Number of Units Expected to Sell
Unified Communications/Follow Me:
Call Answering Service:
ER Dispatching:
Order Taking:
Customer Acquisition:
Dealer Locator:
Appointment Scheduling:
Class, Seminar or Event Registration:
Medical Answering:
Physician Referral:
Donation Acceptance:
Other:
If other, explain:
 
Additional Comments:
Please provide any additional comments that will assist us in better understanding your business.
 
Provider of Outsourced Customer Contact Solutions
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