partner application - design with your success in mind

Fill in the information to enroll in the Preferred Partner Program.

* indicates required fields

Preferred Partner Program Application
Business Information:
Business Name:*
DBA Name:*
Business Address:* Other Address
Address (continued):
City:*
State:*  Zip:* -
Main Business Telephone:*
Federal Tax Id:*
Company Web URL:
Total sales locations:*   Total number of employees:
Officer or Primary Contact Name:
Name:*   Phone:*
Are you a Campus Reseller:*
To qualify for campus reseller status for the Preferred Partner Program, reseller must be a bookstore servicing accredited two-year or four-year college or university ("Institutions"), within the United States, whose primary business is the distribution or resale of computer products to Educational End-Users (Students, Faculty, Staff, and the Institution) by means of a bookstore outlet on a university/college campus. Such a Campus Reseller must be located within one (1) mile of the Institution to which it is affiliated. From time to time, TAIS may run special programs in which only Campus Resellers are eligible.
Yes No
Enter your customer number for each of the following distributors:*
Unless Reseller is a direct customer of Toshiba, Reseller is required to obtain a unique customer number from each Toshiba authorized distributor with which it does business, and to provide those numbers as part of its Application for participation in the Program. When calculating Program benefits, Toshiba will only include those Toshiba Products purchased by Reseller from those Toshiba authorized distributors for which Reseller has provided a unique customer number. If you currently have more than one customer number for any of these distributors, please indicate the additional distirbutor numbers in the comment field below.
Ingram Micro: - Tech Data: Synnex: ICG: Direct Customer:
Tell us which Toshiba products you will be focusing sales efforts on through the program:*
Notebook % Projector % Accessory %
Identify computer manufacturers your organization is presently authorized to sell:
Compaq HP IBM Gateway Dell Other:
Identify computer manufacturers your organization is presently authorized to service:
Compaq HP IBM Gateway Dell Other:
Describe any vertical markets that your organization presently targets:
Manufacturing Government/Education ISPs Retail Utilities Professional Services
Transportation Communications Health Care Financial Services Other:    
Describe the activities you presently use to market and sell into these markets:
Manufacturing Radio & Television Trade Shows Magazine Advertising Web Advertising Telemarketing Campaigns
Yellow Pages Direct Mail Seminars Outdoor Signage Other:    
Total estimated sales revenue by product:
Total Systems:   % $ Peripherals:   % $ Software:   % $ Notebook:   %  
Projector:   %   Services:   % $ Supplies:   % $  
Total estimated sales revenue by end-user segment:*
Medium/Large Business (100+ employees): % Small Business (1-99 employees): % Small Office (1-9 employees): %
Home/Consumer: % Government: % Education: %
Identify additional services offered by this reseller location:
Break-Fix Repair Leasing
End-User Training Consulting
Network Configuration Custom Configuration
On-Site Service Custom Software Programming
Technical Support/Help Desk Other:
Primary Reseller Contacts
  Name Title Phone E-mail
Office or Senior Location Contact*:
Primary Sales Contact*:
Primary Marketing Contact:
Primary Purchasing Contact:
Primary Technical/Service Contact:
Contact for Sales Leads/Referrals*:
Contact for Awards/Rebate Checks*:
Contact for EDI/ Internet Projects*:
Additional Sales Contacts:
Additional Sales Contacts:
Additional Sales Contacts:
Additional Sales Contacts:
Tell us how you heard about the Preferred Partner Program:*
Toshiba Sales Representative Magazine
Distributor: Toshiba Website
Direct Mail Other:

If a distributor referred you, name of person who referred you:
Do you have any questions or additional comments: