HP Business 2 Business Registration Form

Compaq Computer Equipment will continue to be sold through this program along with HP Printers and supplies until further notice.

                            Customer Contact Name:               

                            Title:                                              

                            Department:                                   

                            Email Address:                                

                            Password they would like to use:    

                            Telephone Number:                        

                            Fax Number:                                  

                            Company Name:                            

                            Address:                                         

                            Address:                                         

                            City:                                               

                            State:                                             

                            Zip Code:                                        

                            Order Confirmation Email Address:   

                            Type of Business:                            

                            Yearly Revenues:                            

                            Number of Employees:                   

                            Number of Locations in the US:       

                            Network O/S:                                 

                            Annual IT Budget:                            

                            Number Of Desktops:                      

                            Number Of Laptops:                        

                            Number Of Servers:                        

                            Primary Desktop Manufacturer:        

                            Primary Laptop Manufacturer:          

                            Primary Server Manufacturer:          

                            Primary O/S:                                   

                            Usually purchase equipment by: (ie: retail, reseller, online, catalog)

                            Is your company Tax Exempt?        NO YES

                     (If so, please include a signed copy of your tax-exempt certificate)*required*

                                    (If your company has a 501C3 form on file, be sure to include a copy of the form with this registration)

                                 Completed form will be sent to your HP Account Manager:  Earl Chambers

Reseller's Company Name or Dealer ID#:

Reseller Rep's Contact Name:

Reseller Rep's Email Address:

Reseller Rep's Tele#:

Reseller Address: