First Name: *    Last Name: *

Position/Title: *

Industry:

Telephone: *

E-Mail Address: *

Company Name: *

Company Address: * 

City: *    State: *   

Zip Code: *

Company Website:

Number of Employees:    

Annual Revenues:

Is Your Company Publicly or Privately Owned?

Product Offerings and/or Services: 

International Market Penetration (Please check all that apply): 

Asia Pacific;   

EMEA (Europe, Middle East, Africa);   

Latin America;   

North America

Top Two Competitors:

Do you have partnerships/alliances with other  hardware, software or internet related companies? 

No    Yes   

If yes, please list company names:

Dvergence IT Asset Management Services of Interest to Your Company (please check all that apply):   

Comprehensive Assessment Services;   

Software Compliance Assessments;   

Government Assessment Services;   

M&A IT Risk Exposure / Due Diligence Services;   

"True-Up Reviews;   

Data Center / Server Consolidation Inventory Assistance;   

Human Resource Productivity Analysis;   

IT Asset Management Process and Control Reviews;   

IT Cost Allocation Assessments;   

IT Asset Management Outsourcing.

Where did you learn about us?   

Referral;   

Advertising;   

E-Mail or Postal Mail;   

Search Engine;   

Event;   

Other.