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Business Profile

Note: All fields within this form must be completed prior to submitting for review.

It is a mandatory requirement that all Channel Partners comply with Cisco's minimum partnership requirements listed
within the Indirect Channel Partner Agreement (ICPA). Cisco requires all Partners to grow their business with Cisco’s
vast portfolio of product and service offerings.
Failure to provide evidence of your sales history with Cisco and/or your business plan/pipeline for future orders
along with recognized, tangible supporting evidence (Item #5, below) will result in a rejection of your application
to re-register as a Cisco Partner.

Contact Details of individual completing and submitting this form:

Name (First, Last)

Cisco account login (Email or CCO ID)

Title / Role

1. Your Company’s information:

a) Company Legal Entity Name:

b) Does your company operate under an alternative name? YES NO


If yes, please provide the other name(s): Examples - Fictitious Business name (Operating as), Franchise or Business
Divisions, Trade name or Assumed Name.

c) Company Physical Address:

Address Line 1:

Address Line 2 (Optional):

Address Line 3 (Optional):

City:

State / Province:

Postal / ZIP Code:

Website Address: (www.yyyy.xxx)

Corporate Email Domain: (@zzz.xxx)

*Tax ID/VAT (or country equivalent)

Definition: The unique Tax Identification number (TIN) is required for any company in the country you are applying for
registration with Cisco. Use and validity of a TIN or geographical or functional equivalent will be accepted. (Examples:
Business License Registration Number, Corporate Number, INN, Permanent Account Number, among others) Supporting
evidence may be required for submission during review.

© 2022 Cisco and/or its affiliates. All rights reserved. This document is Cisco Confidential. For Channel Partner use only. Not for distribution
2. Preferred Authorized Distributor Information:

a) Distributor Name:

b) Distributor Account #:

c) Distributor Contact Name:

d) Distributor Contact email address:

3. Cisco Representative: If you have been working with a Cisco contact(s), please provide their full name and
email address. If you do not have a Cisco contact, please enter “N/A” here:

a) Cisco primary contact name (First, Last):

b) Cisco primary contact email address: ([email protected])

c) Additional contact(s) info (Optional. If you need additional space, please attach to this form)

Cisco 2nd contact name (First, Last):

Cisco 2nd contact email address: ( [email protected])

4. Have you or do you intend to sell Cisco products and/or services? YES NO
If your answer is “No”, please describe.

5. If your answer to #4 above is “Yes”, please complete all sections below. Provide documentation in support and
attach to this form. Note: if exact dates and/or prices cannot be provided, supply estimated dates and/or prices.

Cisco Business Plan: Provide and attach your company’s plan for future purchases and / or sales of Cisco Products,
Software Licenses and/or Services include supporting documentation projected for the next 12 months:

Check the boxes for the type of supporting documentation attached: (Select all that apply)

Purchase Order(s) to the Distributor Distributor Quote(s)

Purchase Orders Pending – Ready to Go Sales Pipeline / Funnel (12-18 months projection)

Purchase Orders in Development Deal ID(s)

Customer Purchase Orders

© 2022 Cisco and/or its affiliates. All rights reserved. This document is Cisco Confidential. For Channel Partner use only. Not for distribution
For the supporting documentation you have attached, please complete the table below, with details that are
associated with each item.

Company/
End Distributor Acct # Invoice # Date of Cisco Part Quantity Net Price
Distributor
Customer Name (Reseller Account #) / Deal ID Purchase Number(s) in US Dollars
Purchase

Cisco Annual Sales Bookings Projections (US$): Provide visibility into your Cisco financial targets, annually (select one).
This should align with your responses to 5a and 5c. Note: It is expected that partners grow their sales bookings and
revenue, year over year, increasing their profitability and customer base.

Greater than $100K per year

Greater than $50K US -> $100K Per Year

Greater than $25K US -> $50K Per Year

$10K US - $25K US -> Per Year

Cisco Business History – Provide and attach your company’s list of purchases of Cisco Products, Software Licenses
and/or Services for the past 12 months and provide copies of invoices with your purchase details including
serial numbers.

If you have not purchased any Cisco Products and/or Services within the past 12 months,
enter “None” here:

For the supporting documentation you have attached, please complete the table below, with details that are
associated with each item.

End Company/ Distributor Acct # Invoice # Date of Cisco Part Net Price
Distributor Quantity
Customer Name (Reseller Account #) / Deal ID Purchase Number(s) in US Dollars
Purchased

Americas Headquarters Asia Pacific Headquarters Europe Headquarters


Cisco Sytems, Inc. Cisco Sytems (USA) Pte. Ltd. Cisco Sytems International BV Amsterdam,
San Jose, CA Singapore The Netherlands

Cisco has more than 200 offices worldwide. Addresses, phone numbers, and fax numbers are listed on the Cisco Website at www.cisco.com/go/offices.
Cisco and the Cisco logo are trademarks or registered trademarks of Cisco and/or its affiliates in the U.S. and other countries. To view a list of Cisco trademarks,
go to this URL: www.cisco.com/go/trademarks. Third-party trademarks mentioned are the property of their respective owners. The use of the word partner does
not imply a partnership relationship between Cisco and any other company. (1110R)

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