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1. First Name *(required)
2. Last Name *(required)
3. Email *(valid email required)
4. Company Name *(required)
5. What types of products are you interested in?
6. Cloud Solutions
   Storage Solutions
   OEM Solutions
   Small Business Solutions
   Dell Innovators Credit Fund
   Founders Club
   
7. Found Date of the Company *(required)
8. Are you the Founder, CEO or CFO? * Yes No (required)
9. How many employees do you have? * 1-9 10-49 50-99 100+ (required)
10. Company Phone *(required)
11. Company Website *(required)
12. Have you received Equity Funding in last 18 months? * Yes No (required)
13. If yes, how much?
14. Who are your investors? *(required)
15. Have you purchased Dell Product Technology/Services in last 12 months? * Yes No (required)
16. Are you a company that falls within one of the following industries? * Manufacturing/Engineering/Architecture Healthcare and Life Sciences Finanical Services Web 2.0 Retail/ECommerce B2B software Services Provider (required)
17. Do you have a copy of your investor’s presentation & financial proformas you can share? * Yes No (required)
18. What is your annual IT budget? * Less than $10,000 $10,000 - $50,000 $50,000 - $250,000 $250,000 (required)
19. What types of technology solutions are critical to your business success? * Cloud Hosting Security Manufacturing/Distribution of your product/services Scalable IT Infrastructure Mobility Products and Applications Social Media/Marketing Content Delivery and Management (required)

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