Your Information: * * * * Address 2: * * * * * Fax * Please select which catalog you would like us to send to you: * What is your company's role relative to
Berk-Tek/Ortronics products? * Select one: Contractor/Installer Consultant/Designer Distributor End User Manufacturer/Reseller Other
If distributor; Are you currently a
Berk-Tek/Ortronics distributor?
If other, please specify
What is your company's primary business? Select one: ASP/CLEC/ILEC/ISP/POTS Bank/Finance/Insurance/Legal Broadcasting/Publishing Building Management Colocation/Datacenter/BLEC Commercial/Building Development Communication/Transportation/Utility Consulting Contracting/Installation Design/Engineering Services Distributor/Wholesaler/Reseller Education Government/Military Hospital/Healthcare/Hotel Industrial/Manufacturer Other Corporate Service Firm Residential Development Retail/Chain Other
If other, please specify:
What is your job function? * Select one: Architect Consultant/Designer Contractor/Installer IT/MIS Director Management: Corporate or General Management: IT or MIS Management: Operations Network/System Integrator Project Management Purchasing Agent/Buyer Sales Other
If other, please specify:
Do you make specifying or purchasing decisions for structured cabling products? *
If answer is No; Who does?
Name:
Phone: Which Berk-Tek/Ortronics products are you interested in? GT GT2 GT3 MM1 MM10 SM Current Project: * New Project Upgrade How many workstations or drops are being installed on the network? * Select one: 0-24 25-49 50-99 100-499 500-999 1,000-2,499 Over 2,500 Project Stage:* Select one: Pre-Planning Planning Final Planning Bidding/Purchasing Construction/Installation Other Purchasing Timeframe: * Select one: 0-2 months 3-6 months 7-12 months Over 12 months Indefinite Other Do you have an approved budget? *
What is the estimated budget for your structured cabling system needs? Select one: Less than $1,000 $1,000 - $4,999 $5,000 - $9.999 $10,000 - $24,999 $25,000 - $49,999 $50,000 - $99,000 $100,000 - $499,999 Over $500,000 Not sure Comments or Questions:
