Become an Alcatel-Lucent partner and you will have access to Alcatel-Lucent information and resources that will assist you in selling and supporting Alcatel-Lucent products and services. Resources include sales and technical training, support documentation and other valuable information only provided to Alcatel-Lucent's Channel Partners.

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Company Information
	*Company Legal Name:
	*Company Address:
	*City:
	*State or Province:
	*Zip or Postal Code:
	*Phone Number:
	*Fax Number:
	*Email:
	*Web Address:
	*Alcatel-Lucent Sales Rep:

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Primary Contact Person
	*Full Name:
	*Title:
	*Physcial Address:
	*City:
	*State or Province:
	*Zip or Postal Code:
	*Phone Number:
	*Fax Number:
	*Email:

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Sales Contact
	Full Name:
	Title:
	Physcial Address:
	City:
	State or Province:
	Zip or Postal Code:
	Phone Number:
	Fax Number:
	Email:

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Marketing Contact
	Full Name:
	Title:
	Physcial Address:
	City:
	State or Province:
	Zip or Postal Code:
	Phone Number:
	Fax Number:
	Email:

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Technical Contact
	Full Name:
	Title:
	Physcial Address:
	City:
	State or Province:
	Zip or Postal Code:
	Phone Number:
	Fax Number:
	Email:

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Detailed Company Information
	*Primary Activities?
	*How long has the company been in business?
	*Are you an affiliate or do you have any affiliates? If so, please list name and locations seperately
	*Number of Employees in the company:
	*Number of Sales employees:
	*Territory Coverage:
	*Do you stock product?	Yes No
	*Approximate revenue for current fiscal year?
	*Estimated potential growth for next fiscal year (%)?
	*What were your sales of Alcatel-Lucent product last year?
	*What Alcatel-Lucent products do you currently sell?
	*Do you have a training facility?	Yes No
	*Do you provide product installation and support?	Yes No
	*Number of on-site technical staff?
	*What are the main three product lines that you sell?
	*Do you sell any products that compete with Alcatel-Lucent?	Yes No
	If so, what?

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Product Lines Interested in Selling
	Select all that apply:
	Access Network Division Enterprise Data Division IP Data Division Optical Network Division	Enterprise Voice Division (OmniPCX product) Wireless Transport Division Other
Vertical Market Focus
	Select all that apply:
	K-12 Education Higher Education Banking/Brokerage E-Commerce Utilities Wireless LAN Wireless Communications, Radio	Government Telecommunications IOC RBOC Other Service Providers Healthcare Other

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Brief Company Description