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Preferred VAR Program - Application Form

Please take the time to fill out our Preferred VAR Application form.
Please note: Fields marked with (*) are mandatory.

Primary Reseller Contact Name:
* First Name:
* Last Name:
* Title:
* E-mail [will be used for login]:
* Telephone:
Fax:

Describe your company's business (choose all that apply):
Choose VoIP Vendors [Hold "Ctrl" key for multiple selection]
Choose WLAN Vendors [Hold "Ctrl" key for multiple selection]
Choose IP Camera Vendors [Hold "Ctrl" key for multiple selection]
Cabling Infrastructure	Cabling Infrastructure
Other Business - Please Specify

Target Verticals
Choose all that apply
Other Verticals - Please Specify

Select your preferred distributor:

* Please select your preferred distributor:

How did you hear about the PowerDsine Preferred VAR Program?

Select Desired Password
* Please select desired Password (6 to 10 characters, letters and/or numbers only):


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