Systems Integrator

Organizational Overview

Legal Name *

Legal Address *

Corporate Information

Corporate Legal Name *

Postal Code *

Phone Number *

VAT or CA Resale Number (If Applicable)

Billing Address (If Different)

Select Country *

State

Fax Number

Year Established

Shipping Address (If Different)

City *

Number Of Employees *

Web Address

Street Address

Corporate Contact Information

Name

Title

Telephone

Email

Marketing

Name

Title

Telephone

Email

Sales

Name

Title

Telephone

Email

Name

Title

Telephone

Email

Legal

Name

Title

Telephone

Email

Purchasing

Name

Title

Telephone

Email

Name *

Title *

Telephone *

Email *

Branch Offices

Number of Branch Locations: *

Branch Locations (City/State) *

Requested Territory

In which territory are you requesting to sell Quanika: *

Define your percentage of sales in the following markets:

Physical Access Control Systems (Percentage of Sales)

Digital Video/CCTV Systems (Percentage of Sales)

Emergency Communications (Percentage of Sales)

Intercom Systems (Percentage of Sales)

Remote Monitoring (Percentage of Sales)

Project Management (Percentage of Sales)

Photo/Video ID Badging Systems (Percentage of Sales)

Professional Services (Percentage of Sales)

Security Consuting Services (Percentage of Sales)

Remote Application Management (Percentage of Sales)

Other (Explain) (Percentage of Sales)

Intrusion Alarms/Burglar Alarm Systems (Percentage of Sales)

Federal Government (Percentage of Customer Base)

Police/Corrections/Prisons (Percentage of Customer Base)

College & Universities (Percentage of Customer Base)

Hospitality (Percentage of Customer Base)

Military (Percentage of Customer Base)

Finance/Insurance/Banks (Percentage of Customer Base)

Telecommunication (Percentage of Customer Base)

Healthcare/Hospitals/Medical Centers (Percentage of Customer Base)

Petrochemicals/Mining/Heavy Industry (Percentage of Customer Base)

Manufacturing (Percentage of Customer Base)

Retail (Percentage of Customer Base)

Public Sector (Percentage of Customer Base)

Public & Private School (Percentage of Customer Base)

Utilities (Percentage of Customer Base)

Gaming (Percentage of Customer Base)

Technology (Percentage of Customer Base)

Transportation (Percentage of Customer Base)

General Business (Percentage of Customer Base)

Corporate Real State/Property Management (Percentage of Customer Base)

Biotechnology & Pharmaceuticals (Percentage of Customer Base)

Other (Explain) (Percentage of Customer Base)

List your company’s past and projected total sales for the following years:

2021 Total Sales

2022 Total Sales

2023 Total Sales

2024 Projected Sales

Indicate the percentage of sales based on project size:

Less than $10.000 (% of Sales)

Greater than $250.000 (% of Sales)

$10.000-$50.000 (% of Sales)

$50.000-$100.000 (% of Sales)

$100.000-$250.000 (% of Sales)

Service Contracts (% of Sales)

Access Control Systems (% of Sales)

ID Management Systems (% of Sales)

Video Systems (% of Sales)

Visitor Systems (% of Sales)

Asset Systems (% of Sales)

Fire Systems (% of Sales)

Other (Explain) (% of Sales)

Anticipated Quanika Sales for the following years:

2024

2025

2026

Please provide three (3) end users referrals who have purchased solutions from you within last year

Company

Contact

Telephone/Email

How many people do you employ in the following departments:

Installation Services (# of employees)

Sales Engineering/ Pre- Sales (# of employees)

Field Sales (# of employees)

Technical Support Services (# of employees)

Project Management (# of employees)

How many employees within your company have experience with the following technology platform?

Microsoft Windows

Version(s)

# of Employees

MS SQL Server

Vesrion(s)

# of employees

Storage/Servers/Desktop

Vesrion(s)

# of employees

Network Infrastructure

Vesrion(s)

# of employees

Please check the Hardware Platform(s) your company has experience with:

Option

DELL

HP

IBM

Other (Explain)

List your three (3) primary suppliers for any Technology, Hardware or Database procurement:

Primary Supplier 1

Primary supplier 2

Primary Supplier 3

Microsoft Certified System Engineers (MCSE) (no of employees)

Microsoft Certified Professionals (MCP) (no of employees)

Certified Protection Professionals (CPP) (no of employees)

Quanika Trained Personnel (no of employees)

Certified Network Engineers (CNE) (no of employees)

Please provide the name(s) of any current Quanika trained technician(s):

Quanika Trained Technician 1

How many technicians will you commit to certify with Quanika:

Quanika Trained Technician 2

Quanika Trained Technician 3

I hereby certify that the information provided in this document is true and complete to the best of my knowledge

Name *

Phone *

Title *

Date *

Email *

method