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Application Form

All information provided will be held in the strictest confidence.

* Required Information

Headquarters Information

Company Name*

Address 1*

Address 2

City*

State*

Zip/Postal Code*

Phone Number*

Fax Number

E-Mail Address*

WWW Address

Contact List

Primary Contact: (The Primary Contact is the main contact that we will communicate with for special events and verify contact and company information)

Name*	Title*	Phone*

Fax	E-Mail*

Marketing Contact:

Name	Title	Phone

Fax	E-Mail

Technical Contact:

Name	Title	Phone

Fax	E-Mail

Sales Contact:

Name	Title	Phone

Fax	E-Mail

Company Statistics

Year Company Established:
Major Business:
Total Company Revenue (in thousands):	% of Revenue from System Integration % of Revenue from Distributor % from Other
Number of Employees:	# in Sales # in Technical # Certified Individuals (in other supplier's program, Cisco, Nortel etc.)

Product Mix and Primary Supplier

	Percentage	Primary Supplier
Routers:
Switches:
Access Server:
Network Management:
Security:
Other:
TOTAL	100%

Partnership between other supplier and relevant sales in recent year

Cisco:	Amount (in Thousands)
Nortel:	Amount (in Thousands)
3COM:	Amount (in Thousands)
Others:	Amount (in Thousands)

Technologies and SolutionsServices

Internet Access:	%	Design:	%
Enterprise Class Intranet:	%	Engineering:	%
Campus Network:	%	Installation:	%
Small and Medium business:	%	Management:	%
Small Office/Home Office:	%	Maintenance:	%
IP Telephony:	%	Training:	%
Network Management:	%	Software:	%
TOTAL	100%	TOTAL	100%

Five Largest Customers

1.
2.
3.
4.
5.

Partnership Plan with FutureWei Technologies

How many sales and technical staff will be involved in selling FutureWei products?

Planned Territories?

Annual Sales Commitment for FutureWei Products (in $US thousands)

The marketing promotion plan for FutureWei Products (The steps to reach the annual target):

All information provided will be held in the strictest confidence.