To enroll in 3Com's Focus Partner Program, please complete the New Member Enrollment Form below.

Company Information
Full Company Name (Please no abbreviations or acronyms): *
Address: *
City: *
State / Province / County: United States users please enter only the 2 digit state abbreviation (i.e. Maine = ME): *
Zip / Post Code: *
Country: *	Select One Albania Algeria Andorra Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahamas W. I. Bahrain Bangladesh Barbados Belarus Belgium Bermuda Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Cambodia Canada Chile China Colombia Costa Rica Cote D'Ivoire Croatia Curacao Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Estonia Faroe Islands Fiji Finland France French Polynesia Georgia Germany Greece Guam Guatemala Guyana Honduras Hong Kong Hungary Iceland India Ireland Israel Italy Jamaica Jamaica W. I. Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Latvia Lebanon Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Malaysia Malta Martinique Mauritius Metropolitan Mexico Moldova Monaco Morocco Myanmar Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Republic Of Moldova Romania Russia Saudi Arabia Serbia and Montenegro Singapore Slovakia Slovenia South Africa South Korea Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Trinidad And Tobago Trinidad W. I. Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (U.S.) Yemen Yugoslavia Zambia Zimbabwe
Main Phone or Toll Free Phone: *
Fax: *
Company Web Address:
Corporate E-mail Address:
Do you wish to have your company displayed on 3Com's Reseller/Partner Locator Tool (Where to Buy)? *	Yes   No
If you would like to be featured on this tool, the company information and phone number provided above must be a location where a customer can reach a representative that can refer or sell 3Com product. This information will be verified by 3Com.
Contact Information
	Note: check this box if the contact information below is the same as the company's information. Remaining contact information fields not required if checked.
Country:	Select One Albania Algeria Andorra Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahamas W. I. Bahrain Bangladesh Barbados Belarus Belgium Bermuda Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Cambodia Canada Chile China Colombia Costa Rica Cote D'Ivoire Croatia Curacao Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Estonia Faroe Islands Fiji Finland France French Polynesia Georgia Germany Greece Guam Guatemala Guyana Honduras Hong Kong Hungary Iceland India Ireland Israel Italy Jamaica Jamaica W. I. Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Latvia Lebanon Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Malaysia Malta Martinique Mauritius Metropolitan Mexico Moldova Monaco Morocco Myanmar Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Republic Of Moldova Romania Russia Saudi Arabia Serbia and Montenegro Singapore Slovakia Slovenia South Africa South Korea Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Trinidad And Tobago Trinidad W. I. Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (U.S.) Yemen Yugoslavia Zambia Zimbabwe
Which of the following represents your job function? (Select all that apply) *	Corporate Services Financial Information Systems Marketing Post Sales/Service Purchasing Sales Technical
Which of the following represents your job seniority? *	CEO/MD/Partner Consultant Director/VP/Senior Manager Staff Manager/Lead Other
Which of the following customers does your business focus on?(Select all that apply) *	Small Business (companies with 1 - 99 employees) Medium Enterprise (companies with 100 - 500 employees) Enterprise (companies with 500+ employees) Home & Home Office
Which of the following represents your channel partner type? *	Value Added Reseller / VAR Systems Integrator Service Provider Distributor Direct Marketer/Mail Order Solution Provider (VoIP) Consultant OEM
Which of the following technologies are you interested in? (Select all that apply)	Broadband Access LAN / IP Telephony Modular LAN Network Jack Solutions Network Security Solutions PC Cards/NICs Stackable LAN Voice Solutions Wireless Solutions
Which Vertical markets does your company provide services to? (Select all that apply)	Education Federal Government Finance& Banking Healthcare & Pharmaceuticals Insurance Municipal Government (Canada) Provincial Government (Canada) Real Estate Retail/Wholesale Service Provider - ASP Service Provider - ISP Service Provider - NSP State/Local Government Telecommunications
Would you be willing to participate in surveys to improve our program?*	Yes   No