ASP Application Form

To apply for Visara's Authorized Service Providers program, please fill out and submit the form below:

* marks required fields.

Company Name and Location

* Contact Name:
* Company Name:
* Address:

* City:
* State or Province:	US residents: Please use the two-character abbreviation (e.g. CA) for the name of your state.
* Zip or postal code:
* Country:	If your country is not listed above, please enter it below:
* Telephone:
* Fax:
* Email Address:
* Web Page URL:

General Information

* How long has your service organization been operating?

* What OEM manufacturers do you currently support?

* What is the average length of service experience of your field service personnel?

* Do you have multiple service locations?
	Yes No
* If YES, please list locations:

* Number of Employees:
	Service Management Technical Support Sales Service Operation Repair/Logistics Other
* Check the areas that you are capable of supporting:
	3270/5250 Peripherals Midrange Peripherals Networking Peripherals Mainframes Storage Products PC Products Software Support Other
* Do you offer 7 x 24 service hours?
	Yes No
* Describe the geographic areas you service:

* Do you subcontract any of your work?
	Yes No
* If YES, to whom?

* In what geographic areas?

* Is your company capable of repairing the products you service?
	Yes No

Visara Service/Spares Information

* What is the approximate size of the installed base of Visara, MTX and Memorex Telex equipment that you intend to service?

* Does your company currently have an inventory of Visara spare parts?
	Yes No
* If YES, what is the approximate list price of your Visara inventory?

* If NO, how much is your organization prepared to invest in parts?