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First Name*:
Last Name*:
Job Title*:
Company Name*:
Address:
City:
Province/State:	PROVINCES Alberta British Columbia Manitoba New Brunswick New Foundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory STATES Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming INTERNATIONAL Other
Country *:	Canada United States Other Unlisted Afghanistan Albania Algeria American Samoa Andorra Angola Antigua Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bolivia Bosniaand Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cayman Islands Chad Chile China Colombia N.Ireland Congo Venezuela Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominican Republic Ecuador Egypt ElSalvador Equatorial Guinea Eritrea Estonia Ethiopia F.Y.R. of Macedonia Fiji Islands Finland France French Antilles French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Guadeloupe Guam Guatemala Guinea-Bissau Guinea Guyana Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea (North) Korea Kuwait Kyrgyz Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Mozambique Myanmar Namibia Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda San Marino Saudi Arabia Senegal Seychelle Islands Sierra Leone Singapore Slovak Republic Slovenia Somalia South Africa Spain SriLanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Trinidad and Tobago Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United Kingdom U.S.Virgin Islands Uruguay Uzbekistan Vietnam Western Samoa Yemen Yugoslavia Zambia Zimbabwe
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Referal*:	Please Select One Google YahooReferal News Article Magazine Article GITEX CTIA LMDS Exchange WiMax.com DragonWave Emailer CETPA WiMax World Europe WiMax World USA Other
Business Type*:	Please Select One Broadcasting Fixed Line Carrier Municipality Mobile Carrier Cable Operator Utility Education Healthcare Energy Security Wireless ISP ISP Reseller/Systems Integrator Consulting Firm Manufacturer/Supplier Press Other

Company Overview

1.	Please mark the number of years of experience your company has in each area:
Networking: N/A 1 2 3 4 5+   RF: N/A 1 2 3 4 5+   Wireless (WAN): N/A 1 2 3 4 5+   Install Services: N/A 1 2 3 4 5+
2.	Please estimate your annual revenue in US dollars:
3.	What is the total number of company employees?
4.	What is the number of employees dedicated to:
Networking: N/A 1-5 6-9 10-19 20-49 49+   RF: N/A 1-5 6-9 10-19 20-49 49+   Wireless (WAN): N/A 1-5 6-9 10-19 20-49 49+   Install Services: N/A 1-5 6-9 10-19 20-49 49+

Business Focus

1.	How many years has your company had a wireless focus? N/A 1 2 3 4 5+
2.	What is your business focus (please check all that apply)?
	Small / Medium Business    Energy / Utilties    Financial / Banking    Education
	Government    Healthcare    Municipalities / Countries    Residential
	Service Providers    Other:
3.	Which of the following best describes your business type (please check all that apply)?
	System Integrator    Distributor    Service Provider    Reseller / VAR
	OEM    Other:
4.	What region are you interested in becoming a DragonWave partner?

Product Focus

1.	Do you currently resell wireless products? Yes   No
2.	From which company(s) / distributor(s) do you purchase the majority of your wireless products?
3.	What percentage of your business is gerenated from wireless? Hardware: N/A 0-9% 10-19% 20-29% 30-39% 40-49% 50-59% 60-69% 70-79% 80-89% 90-100%     Installation/Support: N/A 0-9% 10-19% 20-29% 30-39% 40-49% 50-59% 60-69% 70-79% 80-89% 90-100%
4.	What is your current mix of wireless frequencies used?
	Unlicensed: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%     < 10 GHz Pt-Pt Licensed: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
	< 10 GHz Area Licensed: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%     10-15 GHz Licensed: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
	18-26 GHz Licensed: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%     > 26 GHz Licensed: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
5.	What are your typical capacity requirements?
	< 10 Mbps Full Duplex: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%     10-50 Mbps Full Duplex: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
	50-200 Mbps Full Duplex: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%     >200 Mbps Full Duplex: N/A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
6.	On average how many wireless systems do you install per month? N/A 1-5 5-10 10-20 21+
7.	In the next 12 months, what are your sales goals related to the AirPair products and services that you expect to sell? Products:    Services:

Special Requests

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