• Is your company a current partner in the Zebra® PartnerConnect program?*YesNo

What kind of partner would you like to be? *—Please choose an option—Independent Software VendorReseller

What is your primary region? *—Please choose an option—Asia-Pacific (APAC)Europe, Middle East and Africa (EMEA)Latin America (LATAM)North America (NA)

In what country(ies) do you want to represent Zebra Technologies as a Channel Partner? *

• First Name *

• Last Name *

• Email Address *

• Phone Number *

• Mobile Number *

• Primary Role *—Please choose an option—DeveloperExecutiveFinanceKey ContractLegalMarketingOperationsSalesServicesTechnical

• Should this contact be authorized as a Partner Administrator on behalf of your company?*YesNo

• Company Legal Name *

• Company DBA/Trading Name *

• Company Local Name

• Primary Business Address *

• Primary Business Town/City *

• Primary Business Country *

• Primary Business State/Provinces *

• Primary Business Postal Code *

• Primary Business Phone Number *

• Headquarters Address *

• Headquarters Town/City *

• Headquarters Country *

• Headquarters State/Provinces *

• Headquarters Postal Code *

• Headquarters Phone Number *

Company Information

• Company ID Type *—Please choose an option—Government IDTax Registration IDNot Applicable

• Company ID *

• Which business model best reflects your company's go to market approach? * —Please choose an option—Application partner / Developer IntegratorCarrier / Service providerConsulting Services ProviderDirect MarketerE-TailerInstallation Service ProviderInternet Service ProviderISVNetwork / System IntegratorRetail StoreValue Added ResellerWireless Service Provider

• Do you develop any software / firmware solutions? YesNo

• What categories of product do you sell? * —Please choose an option—Barcode ScannersComputers & TerminalsLabels, Tags & RibbonsNetworksPrintersRepair ServicesRFIDSoftwareSupport Services

• Primary Company Website *

• If there are any additional websites associated with your company, please provide the additional URL(s). If more than one, use comma to separate.

• Please provide a short description of your company and the value you provide to the market. (Please note that any details provided can be used on the Zebra Technologies Partner and Application Locator.) *

Company Sales and Revenue

• What was the total sales and services revenue generated by your company in its last fiscal year (USD)? *—Please choose an option—$0 - $150,000$150,001 - $600,000$600,001 - $1,000,000$1,000,001 - $3,000,000$3,000,001 - $5,000,000$5,000,001 or more

What percentage of your sales directly results from the following sales methods in the last fiscal year? (Must total 100%)

• Face-to-Face / Field Sales *

• Via internet with limited human interaction *

• Telephone Based Consultative Sales Resources *

• Via Printed Catalog *

• Do you have a single primary vertical market? *NoYes

• Please select the cross-vertical market focus for your company? *—Please choose an option—Middleware/MEAP/PlatformRapid-App-Development ToolGPS NavigationLocation Based Service/GISVoice recognitionPTT (Push to Talk)RFIDVideo-Streaming-RecordingDevice ManagementAnti-VirusMobile VPNData Encryption/BackupLabel Design & ManagementPrint Output Utility/ToolWireless Network ToolsData/Image Capture & OCR VR/AR Tools & Video AnalyticsTerminal Emulation

Identify the percentage of revenue your company derives from hardware, software, media and services sales. (Must Total 100%)

• Hardware *

• Customer Support and Services *

• Professional and Advanced Services *

• Software *

• Media *

Please specify the number of employees by job category. (If a person has multiple roles, please only count them in one category).

• Total Number of Company Employees *

• Total Number of Technical Employees *

• Total Number of Developer Employees *

• Total Number of Sales Employees *

• Total Number of Services Employees

Anti Corruption

Please note that all questions are pre-populated with the answer “NO”

We request that you review each question and select the answer that applies to your company. All fields are required. Upon completing your response to each question, you are required to review the Anti-Corruption Certification, and if uyou agree, click the radiol button and submit.

• Please state all the countries where your company will conduct business and/or ship Zebra products or supplies on behalf of Zebra. *
  

• Does your company have a code of Business? *NoYes

• Does a current or former government employee or any member of his immediate family, have an ownership interest in your company? *NoYes

• If yes, what % of ownership does the person have?

• Is a current or former government employee or current or former employee of a Government-owned company or any member of his immediate family, employed by your company? *NoYes

• If yes, please provide the employee's name(s).?

CONFIRMATION

• I certify that I, and the company that I hereby represent, will abide by all applicable anti-corruption laws and regulations, including but not limited to, the U.S. Foreign Corrupt Practices Act, the U.K. Bribery Act, and similar anti-corruption laws, and will conduct business without the use of bribery, in any form.

  I also represent and warrant that:

  (i) Company is not located in, under the control of, or a national or resident of Cuba, Iran, north Korea, Sudan, and Syria and it will not transfer, export, or re-export, directly or indirectly, any products, software or technology, including techinical data Company receives from Zebra directly or indirectly (collectively, the "Supplied Items"), to such countries or to any nationals thereof;

  (ii) Company will not use Supplied Items in any activity related to the development, production, use, maintenance, or proliferation of weapons of mass destruction, and Company will not transfer, export, or re-export, directly or indirectly, Supplied Items, to any party engaged in any such activity; and

  (iii) Company will not transfer, export, or re-export any Supplied items, directly or indrectly, to any party identified on a restricted party list publisehd by the U.S. government or any other government.

  Agree