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  1. Please provide the following Company Contact information:

    Name
    Title
    Company
    Street Address
    Address 
    City
    State/Province
    Zip/Postal Code
    Country
    Main Phone
    FAX
    E-mail required
    URL

    Do you agree to the Intelliphone Certified Converged Technology Partner Program Policies and Procedures stated above. ?

    Yes No


    1. Please check the quantity of employees at your company:

      1 to 5 full time staff
      6 to 20 full time staff
      21 to 50 full time staff
      51 to 100 full time staff
      101 plus full time staff

    2. Please provide us with the proper contact person at your company or outside agency for certificate of insurance and other insurance related matters:

      Name
      Title
      Organization
      Street Address
      Address (cont.)
      City
      State/Province
      Zip/Postal Code
      Country
      Work Phone
      FAX
      E-mail
    3. Please check if you can forward certificate of insurance, by mail to Intelliphone, Attn: Insurance Department, 191 Chandler Road, Andover, MA 01810, or by fax to 978-688-3980

      We have sent a Certificate of Insurance

    4. Please provide the following contact information for the person to resolve technical issues :

      Name
      Title
      Work Phone
      FAX
      E-mail
    5. Please provide the following contact information for the person to co-ordinate installation scheduling :

      Name
      Title
      Work Phone
      FAX
      E-mail
    6. Please provide the following contact information for the person to schedule service orders:

      Name
      Title
      Work Phone
      FAX
      E-mail
    7. Please provide the following contact information for the person to schedule sales appointments if required:

      Name
      Title
      Work Phone
      FAX
      E-mail
    8. Please provide the following contact information for the person to schedule user-admin training:

      Name
      Title
      Work Phone
      FAX
      E-mail
    9. Select any of the following DataCom Technical Certifications that apply to your company:

      CCNA Certification
      CCNE Certification
      MSCE Certification
      MSCE Windows 2000 Certification
      MS Software Partner Certification
      Novell NetWare Certification
      Cisco IP Telephony Certification
      ISO 9000 Certification

    10. Select any of the following Legacy Telecom Technical Certifications apply:

      Lucent Partner Certification
      Lucent Definity Certification
      Lucent Audix Certification
      Lucent Octel Certification
      Nortel Norstar Certification
      Nortel Meridian Certification
      NEC Electra Certification
      NEC NEAX2000 Certification
      NEC NEAX2400 Certification
      Seimens HiCom Certification
      Seimens Rolm 9751 Certification
      Mitel SX200 Certification
      Mitel SX2000 Certification
      Toshiba Certification
      Comdial Certification
      TelRad Certification
      InterTel Certification
      Panasonic KXT Certification
      Panasonic DBS Certification
      Active Voice Certification
      AVT Certification

    11. Select any of the following Server-Based, LAN Based or IP Based System Technical Certifications that apply:

      3Com NBX25 Certification
      3Com NBX100 Certification
      3Com NBX SuperStack3 Certification
      3Com Call Center Certification
      3Com IP Contact Center Certification
      Cisco AVVID 7750 Certification
      Cisco AVVID 7825 Certification
      Cisco AVVID 7835 Certification
      Cisco Active Voice Certification
      Cisco I3 Call Center Certification
      Picazo VS1 Certification
      Intel Communications Platform Certification
      Vertical Networks InstantOffice Certification
      InterActive Intelligence Certification
      Shoreline Certification
      Estech IVX Series Certification
      Estech IP Series Certification
      Avaya IP600 Certification
      Nortel BCM Certification
      NEC IP Express Certification
      Seimens OfficePoint Certification
      Mitel IPera2000 Certification
      Artisoft TeleVantage Certification
      Altigen AltiServ Certification
      COM2001 NTX Certification
      InterTel Call Server Certification

    12. Select any of the following Premise Wiring Certifications that apply:

      Lucent Premises Wiring Certification
      Ortronics Wiring Certification
      Hubbell Wiring Certification
      Seimon Wiring Certification
      Panduit Wiring Certification
      Thomas & Betts Wiring Certification
      Leviton Telecom Wiring Certification

    13. Select any of the following Data Com products that your company sells that apply:

      Cisco Routers
      Cisco Catalyst Switches
      Cisco AeroNet Wireless
      3Com Hubs
      3Com Switches
      3Com NICs
      Intel Hubs
      NetGear Hubs-Switches
      Nortel Networks Routers
      Nortel Networks Hubs-Switches
      Motorola Routers
      Adtran CSU-DSU-Muxes
      Kentrox CSU-DSU-Muxes
      Compaq Servers - Desktop PCs
      HP Servers - Desktop PCs
      IBM Servers - Desktop PCs
      Dell Servers - Desktop PCs

    14. Select any of the following Legacy Telecom products that your company sells and/or supports that apply:

      Lucent - Avaya Partner
      Lucent - Avaya Legend
      Lucent - Avaya Definity
      Lucent Merlin
      Lucent - Avaya Audix Voice Mail
      Lucent - Avaya Octel Voice Mail
      Nortel Norstar
      Nortel Startalk Voice Mail
      Nortel Meridian PBX
      Nortel Meridian Mail
      Seimens HiCom
      Seimens - Rolm 9751
      NEC Electra Professional
      NEC Electra Elite
      NEC ElectraMail
      NEC NEAX2000
      NEC NEAX2400
      NEC NEAX Mail
      Mitel SX200
      Mitel SX2000
      Comdial DXP
      Comdial Executech
      Intertel AXXESS
      TelRad KeyBX
      Toshiba Strata
      Fujitsu Starlog
      Iwatsu ADIX
      Iwatsu Omega
      Panasonic KXT
      Panasonic DBS

    15. Select any of the following Server, LAN or IP Based Telephone systems your company sells and/or supports that apply:

      3Com NBX25
      3Com NBX100
      3Com NBX SuperStack3
      3Com Call Center
      3Com IP Contact Center
      Cisco AVVID 7750
      Cisco AVVID 7825
      Cisco AVVID 7835
      Cisco Active Voice
      InterActive Intelligence
      Estech IVX Series
      Estech IP Series
      Picazo - Telecor VS1
      Intel ICCP
      Altigen AltiServ
      Artisoft TeleVantage
      Shoreline ShoreGear
      COM2001 Alexis Internet PBX
      Mitel IPera
      NEC IP Express
      Nortel BCM
      Avaya IP600
      Alcatel PCX4400
      Ericsson WebSwitch 2000

    16. Select any of the following Services your company can provide without the use of sub-contractors that apply:

      Cat 3 Wiring - Certification
      Cat 5e Wiring - Certification
      Cat 6 Wiring - Certification
      Fiber Optic Wiring - Certification
      Trouble Shoot Wiring Systems
      Install Hubs - Switches
      Install Wire Management
      Install - Program - Test Routers
      Install - Program - Test CSU-DSU-Muxes
      Install - Configure - Test NT Servers
      Install - Configure - Test Win2000 Servers
      Install - Configure - Test NetWare Servers
      Install - Configure -Test Win95/98 Desktop PCs
      Install - Configure - Test WinNT/2K Desktop PCs
      Install - Configure - Test TAPI Application Programs
      Install - Configure - Test Contact Mgmt Programs
      Install - Configure - Test Database Programs
      Install - Configure - Test IVR Application Programs
      Install - Configure - Test Key Telephone Systems
      Install - Configure - Test Hybrid Telephone Systems
      Install - Configure - Test PBX Telephone Systems
      Install - Configure -Test Voice Mail Systems
      Install - Configure - Test ACD Systems
      Install - Configure -Test Server Phone Systems
      Install - Configure - Test LAN Based Phone Systems
      Onsite Field Service - Router Products
      Onsite Field Service - LAN-WAN Products
      Onsite Field Service - Server-PC Products
      Onsite Field Service - Applications Software
      Onsite Field Service - Telephone System Products
      Telephone Support - Router Products
      Telephone Support - LAN-WAN Products
      Telephone Support - Server-PC Products
      Telephone Support - Applications Software
      Telephone Support - Telephone System Products
      Remote Access Support - Router Products
      Remote Access Support - LAN-WAN Products
      Remote Access Support - Server-PC Products
      Remote Access Support - Application Software
      Remote Access Support - Telephone Systems
      Onsite User Training - Telephone Systems
      Onsite User Training - Software Applications
      Onsite Admin Training - Router Products
      Onsite Admin Training - LAN-WAN Products
      Onsite Admin Training - Software Applications
      Onsite Admin Training - Telephone Systems

    17. Does your company have field service technicians on call? If so, please provide your on-call after hours telephone number


    18. Enter your Service Technician Labor Rate per hour.


    19. Enter your Service Technician Overtime Labor Rate per hour.


    20. Enter your Installer Labor Rate per hour.


    21. Enter your Installer OverTime Labor Rate per hour.


    22. Enter your Travel Rate per hour.


    23. Enter your Minimum Billing amount


    24. Enter your Onsite User Training Rate per hour


    25. Enter your Telephone Support Rate per hour


    26. Enter your Remote System Access Rate per hour


    27. Enter your 8AM to 5PM OnSite Service Contract Rate per port per year.


    28. Enter your 24Hour 7Day Service Contract Rate per port per year.



    Please Print out three copies of the completed Intelliphone Certified Converged Technology Partner qualification form and sign below, please retain one copy for your records and mail two signed copies to:

    Intelliphone, Inc.
    Certified Converged Techology Partners Program
    191 Chandler Road
    Andover, MA 01810

    For Partner Program Applicant 

    Authorized Name:______________________________________

    Authorized Signature:___________________________________

    Company:___________________________________________

    FED ID Number:______________________________________

    Date:_______________________________________________

     

     For Intelliphone, Inc.

    By Chuck Garabedian, President

    Intelliphone Signature:___________________________________

    Date:_______________________________________________

     
















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