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Print Form Section One: Company Information Company Name: Ingram Micro Account Number: Management Contact (Management...

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Section One: Company Information Company Name:

Ingram Micro Account Number:

Management Contact (Management contact to commit to participation and develop Cisco Strategy) Title: Name: Email Address: Phone Number: Sales Contact (Sales Associate to receive program communication and act as a Cisco Sales Champ within your organization): Title: Name: Email Address: Phone Number: Technical Contact (Associate to receive product information and act as a Technical Champion within your organization): Title: Name: Email Address: Phone Number: Purchasing Contact (Associate to receive ordering tools and process training) Title: Name: Email Address: Phone Number: Marketing Contact (Associate to receive Marketing resources) Title: Name: Email Address: Phone Number: Referral: Ingram Micro or Cisco Employee who referred you to the APB Program:

Section Two: Program Details Trainings will be offered in various regions in Canada based on customer participation in the program. For those located outside of a targeted region, webinars will also be offered for some of the training components of this program. Please provide us with the location in which you would be able to attend live trainings (“x” all that apply): Vancouver: Toronto: Other (Please Specify):

Montreal:

Calgary:

Edmonton:

Halifax:

Ottawa: __

Please identify what Cisco technologies your company is interested in learning more about: Security: Wireless: Other (Please Specify): Unified Communications: Please acknowledge the following program details by placing an “x” in all spaces: • I authorize my organization to be entered into the Cisco SMB Rewards program and that my organization will earn 10 ballots in the draw for every $2500 in Cisco products or Services purchased through Ingram Micro. ____ • I accept that program updates and Cisco promotions may be sent to the contacts provided as an applicant to the program and may be removed from the list upon request. • The right to remove membership privileges of this program is at the discretion of Ingram Micro and Cisco Systems. ____ • Training classes within this program are offered at no charge to me the reseller (unless otherwise specified in the invitation), however travel and accommodations are to be covered at my own expense. ____

Thank you for your participation, and welcome to the APB Program!