Name

Company Name

Address

City

State

Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon

Zip

Phone

Fax

e-mail

Servers installed:

AS400 (iSeries)

NT 4.0

W2K Server

Linux

RS6000 (pSeries)

Unix Host

Domino

S390 (zSeries)

Industry

Manufacturing

Healthcare

Distribution

Government

Retail

Other:

Scanner

LXE 8650

Intermec CK31                      

Symbol LS2208

Honeywell 3800g     

Number of units you could deploy?

1 2-5 6-9 10+

Timeframe for deployment?

Immediate 30 days 1-3 months 4-6 months 6+ months

I heard about these products from…

Direct mail piece

Trade show/seminar

Display ad in magazine

Yahoo/Web search

Referral

Other