Date*
:
Company Profile
NOTE : PLEASE FILL IN THE FORM WITH ALL CAPITAL LETTERS
 
Company*
:
Key Contact Person*
:
Name :   Title :  
Department   Email :  
Phone :   Mobile :  
Business Decision Maker*
:
Name :   Title :  
Department   Email :  
Phone :   Mobile :  
Sales Contact*
:
Name :   Job Title :  
Department   Email :  
Phone :   Mobile :  
Marketing Contact*
:
Name :   Job Title :  
Department   Email :  
Phone :   Mobile :  
Technical Contact*
:
Name :   Job Title :  
Department   Email :  
Phone :   Mobile :  
Finance Contact*
:
Name :   Job Title :  
Department   Email :  
Phone :   Mobile :  
Form Submitted by*
:
NOTE: The below email address will be receiving a copy of the submission info.
Email Address*
:
Note : All the below fields are mandatory
Years of experience (in IT business):*
:
Year Months
Number of Employees*
:
Total Management Sales Marketing Technical
              
Others        
          
Type of Business*
:

Note : Please equally divide the Total Revenue into 4 quarters if you are not sure of the exact Revenue for each quarter
 
Annual Revenue (Past 1 year)*
:
Total ($ MYR) Q1 Q2 Q3 Q4
         
Tech Titan Distribution Revenue
(Past 1 year / if any)
:
Total ($ MYR) Q1 Q2 Q3 Q4
Product Focus (Y/N)*
:
 Desktop/Notebook   Server   Storage   Software   Security 
              
Services        
          
Product Revenue Mix % (Total 100%)*
:
 Desktop/Notebook   Server   Storage   Software   Security 
              
Services        
          
Targeted Tech Titan Distribution Share of Wallet (SOW)% (ie. Within the first year of partnership)*
:
Product Ownership (ie. Do you sell your own branded product/solution ?)*
:
Partnership with other Vendor (Y/N)*
:
Symantec Mcafee Trend Micro Sophos Others (Please specify)
Geographical Coverage (Y/N)*
:
Single Location (Y/N) Multi-location* (Y/N) *if multi location, which cities ? Number of locations
Primary Customer Segment (Y/N)*
:
Consumer SMB (1-99) MB (100-500) LE (>500) PUB/LE (>500)
              
Secondary Customer Segment (if any)
:
Consumer SMB (1-99) MB (100-500) LE (>500) PUB/LE (>500)
              
Certifications (Y/N)*
:
Microsoft EMC Oracle Citrix VMWare
Cisco Others Please specify:      
     
Services Offered (Y/N)
Describe Services if Any*
:
Description of Services Details of Services if any
Network Integration    
Hardware & Software support    
On-site Break-fix/ Maintenance  
Helpdesk / TeleSupport         
Quality Assurance Systems              
Vendor Certified Training              
Parts Inventory        
Managed Services               
Infrastructure Consulting              
Others: 
Horizontal Solutions Provided (Y/N)
Describe Solutions if Any*
:
Description of Solutions Details of Services if any
Virtualization    
Infrastructure consolidation    
Messaging & Collaboration  
Business Continuity & Disaster Recovery         
Database Management / Optimization              
Security Solutions              
Systems Management        
High Performance Computing               
Others: 
Vertical Markets (Y/N)*
:
Industry (Y/N)
Finance   
Insurance    
Government  
Home         
Telecom              
Transport              
Distribution        
Manufacturing               
Petroleum              
Education 
Others 
Vertical Markets
Describe Solutions if Any
:
Industry Details of Vertical Solutions if any
Finance   
Insurance    
Government  
Home         
Telecom              
Transport              
Distribution        
Manufacturing               
Petroleum              
Education 
Others 
Other Remarks (Free Text)
:
Declarations*
:

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