Business Profile

This form must be completed in its entirety in order to be considered.

Please note Cisco’s decision on your application to re-register as a Partner may depend on your evidence of a Sales
history with Cisco and/or your business plan/pipeline for future orders (Q5).

1. Your Company’s information:

 Company name:
 Does your company do business under a different name? Examples: "fictitious business name," "trade name,"
or "assumed name." If yes, please provide the other name(s):
 Company Physical Address:
 Website Address:
 Corporate Email Domain:
 Name and CCO ID of individual completing and submitting this form:

2. Cisco representative: If you have been working with a Cisco contact(s), please provide their full name and email
address. If you do not have a Cisco contact, please enter “N/A” here: _____
 Cisco contact name:
 Cisco contact email address: @cisco.com

3. Have you or do you intend to sell Cisco products and/or services? (Yes or No)
If your answer is “No”, please describe your non-reseller relationship with Cisco.

4. Preferred Distributor Information:

 Distributor Name:
 Account #:
 Contact Name:
 Contact email address:

5. If your answer to #3 is “Yes”, please COMPLETE both Tables & Columns below.
Where Values are requested, add Estimation
Where dates are requested, add Estimation
 5A List Purchases of Cisco Products and/or Services for the past 18 months and provide copies of invoices with
your purchase details including serial numbers. (Copies of invoices will reduce the time to process your case.)
 If you have not purchased any Cisco Products and/or Services within the past 18 months, Type “None” below.
End Company / Distributor Acct # Invoice# Date of Cisco Part Quantity Net Price
Customer Distributor (Reseller Account #) Purchase Number(s) in US
Name Purchased Dollars

 5B Business Plan: List information about your company’s plan for future purchases/sales of Cisco Products
and/or Services, and provide supporting documentation (i.e., customer PO, customer Letter of Intent,
distributor quote, reseller PO to the distributor).
6. Where Values are requested, add Estimation
7. Where dates are requested, add Estimation

End Name of Type of Supporting Deal ID Expected Cisco Product Net Price
Customer Cisco Documentation or PO# Date of Family/Solution in US
Name Distributor Provided Purchase Dollars