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GEM Program Pricing Request Form

GEM Level 1
Thank you for your interest in Two Technologies. Please provide the following information. We will be in contact with you once your application has been reviewed and approved. Please note that all fields are required.

Company Information:
*Company Name:
    
*Contact Name:
    
*Title:
    
*Address 1:
    
Address 2:
  
*City:
   
*State (U.S. Only):
    
Province:
  
*Country:
    
*Zip/Postal Code:
   
*Phone Number:
   
*Fax Number:
 
*Email:
   
*Website:
    
 
*How did you hear about Two Technologies?
 

Business Information:
 
*What is your business model?
 
*Year business established
 
*Annual gross sales
 
*What is your anticipated purchase level of Two Technologies hand held computer products?
Do you have staff that will be dedicated to technically supporting Two Technologies' products?      
Yes        No
*How many technical/technical support people do you employ?
 

Technical Contact Information:
 
*Name:
 
 
*Phone Number:
 
 
*Email:
 
 
Where is your application software developed?
 
In-house (CE programmers on staff)
           Number of CE programmers 
 
GEMPASS
Other    
*List all peripherals, hardware and software your company sells including those products competitive with Two Technologies:
 
 
*Please list any certifications you have received for your hardware/software solutions (specifically those related to DOS, Microsoft® Windows® CE or CE .NET):
 
*Please list any other partnerships that you are involved with:
 
 

Marketing Information:
*What Two Technologies hand held computer products are you interested in?
 
Hydrus™
JETT•eye™
JETT®•ce
JETT®•RFID+
JETT•XL®
PDSRF
PSMT
PDS
*Please list your targeted industries:
 
Warehousing/Distribution
Technical/Field Service
Manufacturing
Utilities
Transportation
Defense/Military
Supply Chain/Logistics
Security
Healthcare/Medical
Mobile/GPS/GSM
Surveying
Other (please specify):
*Typical Application Descriptions:
 
 
*Please provide a brief description of your product solutions:
   
 
By clicking the Submit button below I affirm that the statements provided in this application are true and complete to the best of my knowledge.
I understand that the information Two Technologies will provide upon the acceptance of this GEM Program Pricing Request Form is confidential information and should be treated accordingly.

Two Technologies reserves the right to reject any application that does not adequately meet our  requirements.

I understand that this Application is valid for the period of one year from the date of approval. This Application may be cancelled at any time by either party.