Account Application

(Please complete in as much detail as possible)
Lead Practice
Registration for *:
Comstor
Westcon Security
Westcon UCC
Westcon Services
Contact Person
(if already exists):
Company details
Company Name *:
Address Line 1 *:
Address Line 2:
City / Postcode *:
Country *:
Phone*:
EMail *:
Homepage *:
Company Registration Number :
VAT No *:
Certificate of registration / Business registration *:
Please note that we only sign up your company as a customer on production of your certificate of registration or include your business registration. Please enclose your certificate of registration or your business registration, when sending back the Account Application.

Finance contact
EMail for invoices*:
Billing address it differs from the company address? *:
Yes
No
Address Line 1.*:
Address Line 2:
City / Postcode *:
Country *:
Credit
Bank name*:
IBAN :
SWIFT / BIC :
Amount :
Currency :
EUR (€)
USD ($)
EMail *:
Sales Director
Last name *:
First name *:
Title :
Phone :*
EMail *:
Sales Contact
Same as sales director *:
Yes
No
Last name *:
First name *:
Title :
Phone *:
EMail *:
Purchase Contact
Last name :
First name :
Title :
Telefon :
EMail :
Technology Contact
Last name *:
First name *:
Title :
Phone *:
EMail *:
Vendors
Which vendors do you sell?:
Westcon UCC:
Avaya
Extreme Networks
Polycom
Mitel
Microsoft

Westcon Security:
Blue Coat
Check Point
F5 Networks
Palo Alto
Trend Micro
Juniper Networks

Comstor:
Cisco
Cisco Meraki
Purple WiFi
SimpliVity
Microsemi
further:
Technology Aspects & Target Markets
Your technology aspects? *:
Enterprise Networking
Security
Data Center/Virtualisierung
Unified Communications
Internet of Things
further:
What is your target market focus? :
Authorities
Banks
Logistics
Health Care
Manufacturing
Edication
Retail
further:
Which company size you specialize in? :
less than 100 employees
less than 250 employees
less than 500 employees
more than 500 employees
Confirmation
Last name *:
First name *:
Title :
Phone *:
EMail *:





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