IBM Registered Reseller Program Application

Please ensure all sections are complete or marked N/A.

1. Distributor:
Distributor who referred you to register:*

2. Application information:
Company legal name:* (as it appears on your commercial registration)
Carry-on business name:*
Company address:* (Can not be a Post Office Box)
City:*
State/Province:*
Country:*
Postal code:*
Date business founded:*
Year of Registration:*
Number of Full Time Employees:
PST#:*
GST#:*
Company telephone number:* (including Country Code)
Company fax number:* (including Country Code)
Web address:*
Owner/principal:* (First & last name)
Title:*
e-mail:*
Telephone:*
Primary contact name:* (First & last name)
Title:*
E-mail:*
Telephone:*
Key contact for Contractual matters:* (First & last name)
E-mail:*
Telephone:*
Chief Executive/Managing Director:* (First & last name)
E-mail:*
Telephone:*
Sales Director/Manager:* (First & last name)
E-mail:*
Telephone:*
Finance Director:* (First & last name)
E-mail:*
Telephone:*
Authorized Contract Signatory:* (First & last name)
E-mail:*
Telephone:*
Preferred language:	English French

3. Ownership and Control Information:
Please identify your ownership and control structure, including: 1) all persons or entities with 5% or more, direct or indirect, ownership or control, 2) identify any ownership or control, by any government entity, government official, or government employee "Indirect" ownership includes ownership through familial relationships, and 3) identify if your company is owned by another company, companies, persons, or entities have a business partner relationship with IBM. If Yes, please explain and describe relationship and include name(s)*

If your company is owned by another company, companies, persons or entities, do any of these companies, persons, or entities have a business partner relationship with IBM? If yes, please describe the relationship

To the best of your knowledge are any of your company's employees, board members or officers: 1. Government officials, or 2. Do they have indirect ties to government (ie. Through familial relationships) that allow them to influence or approve any government spending, procurement, and/or investment decisions?
YesNo
If yes, please explain

Are your bank accounts located in the same country where the company is legally registered?
YesNo
If No, please explain the reason for having off-shore bank accounts.


4. Ethical Conduct To the best of your knowledge, have you or any of your employees, board members, or officers ever been investigated for, or charged by, any jurisdiction with engaging in illegal activity related to unethical conduct, such as bribery or corruption?
YesNo
If yes, please explain.

Does your company's business model include computer leasing, broker or used equipment business as a primary offering, or is it a subsidiary of one that does:
YesNo
If yes, please explain

What percentage of your total company revenue is from:
Leasing
Used equipment (refurbished)
Computer equipment broker


5. IBM Employment Are any of the contacts in this applications or any key personnel of your company a current or past employee of IBM?
If yes please provide names, dates and IBM employee number for person worked at IBM

6. Certification Statement:
1. You certify that you have furnished the above answers truthfully and accurately and will advise IBM of any changes in the information provided above, within 30 days of the changes being made,
2. You acknowledge that you have read, understood and that your company will agree to abide by the terms of the IBM Business Partner Code of Conduct found at: http://www-2000.ibm.com/partnerworld /pwhome.nsf/weblook/pub_join_memctr_agreement_code.html
3. Your company will participate in IBM Integrity Training should your company be approved as an IBM Business Partner. This training will be provided by IBM through an outside vendor. The timing and requirement to complete this training will be communicated to you at a future date.
This application questionnaire must be acknowledged and dated by an authorized contract signator
Name
Title
Date

I have read and agree to the Terms and Conditions
(English | French) of the IBM Registered Reseller Program.