Supplier Enrollment Application

Thank you for your interest in supplying to Connection. In order for your company to be evaluated for sales and solutions opportunities within Connection, please completely fill out and submit this form. Based on the high number of applications received, we will respond to you as opportunities arise.

PLEASE NOTE: All fields preceded by an asterisk (*) are required.

Contact Information

*Company Name:

*Contact Name:


Street Address:




*Phone Number:

*Email Address:

Website Address:

Company Profile Information

Are you a manufacturer/distributor?
Manufacturer     Distributor

Please describe your company's product line:

Does any portion of your product line require authorization?
Yes     No

If yes, briefly describe the authorization process.

If manufacturer, is your product line available through the following distributors? (Select Multiple Distributors by holding down the control key.)

Ingram Micro
Tech Data

Please list other distributors:

If your product line is not available through any of the above distributors, please list where Connection can source your product.

Does your company sell through other resellers?
Yes     No

If yes, please list authorized resellers:

Does your company have EDI capabilities?
Yes     No

If yes, what transaction sets?

What makes your product line unique?

Does your company utilize or participate in any Corporate Social Responsibility activities?
Yes     No

If yes, please describe these activities or policies. Additional documentation may be requested.

Marketshare Information

What is your company's target market?

Please list any vertical markets:

Please list your top product competitors:

Is your company currently doing any business with Connection?
Yes     No

If so, what are your annual sales?

Marketing Information

Does your company offer Marketing Dollar Funds (MDF) or Co-op funds?
Yes     No

If yes, what are your company's MDF reimbursement requirements?

Enter Verification Code:
(case sensitive)