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Residency <br />Responding Company’s principal place of business is in the city of ______________________, <br />State of _________________. <br />Felony Conviction Notice <br />Please Check Applicable Box (If the 3rd box is checked, a detailed explanation of the names and <br />convictions must be attached): <br /> A publicly held corporation; therefore, this reporting requirement is not applicable. <br /> Is not owned or operated by anyone who has been convicted of a felony. <br /> Is owned or operated by the following individual(s) who has/have been convicted of a felony <br />Distribution Channel <br />Which best describes your company’s position in the distribution channel: <br /> Manufacturer Direct Certified education/government reseller <br /> Authorized Distributor Manufacturer marketing through reseller <br /> Value-added reseller Other: ______________________________________ <br />Processing Contact Information <br />Contact Person __________________________________________________________ <br />Title __________________________________________________________ <br />Company __________________________________________________________ <br />Address __________________________________________________________ <br />City/State/Zip __________________________________________________________ <br />Phone __________________________________________________________ <br />Email __________________________________________________________ <br />Pricing Information <br />In addition to the current typical unit pricing furnished herein, the Vendor agrees to offer all <br />future product introductions at prices that are proportionate to Contract Pricing. If answer is no, <br />attach a statement detailing how pricing for NCPA participants would be calculated for future <br />product introductions. <br /> Yes No <br />Sunnyvale <br />California <br />X <br />X <br />Jerilyn Bailey <br />Public Sector Contracts Manager <br />Fortinet, Inc. <br />899 Kifer Road <br />Sunnyvale, CA 94086 <br />(850) 728-6504 <br />baileyj@fortint.com <br />X