Novell® SecureLogin 6.1

First Name

Last Name

Title

Company Name

Company Address 1

Company Address 2

City

State/Province Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon

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Country Choose a Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Taiwan, Republic of China Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Business Phone

E-mail Address

How many networked PCs does your organization have? Select a number... 0 - 500 501 - 1000 1001 - 2000 More than 2000

What is your timeframe for purchasing a secure identity management solution? Select a time frame... 0 - 6 months 6 - 12 months 12 -18 months not at all

Select the platform where users will be defined and managed: Select your platform... Novell e-directory Novell Directory Services (Netware 4) SecretStore Microsoft Active Directory i Planet LDAP NT 4 Domain other directory

How did you hear about Novell SecureLogin? Select a source... Novell Connection magazine Brainshare Nice Brainshare SLC Direct Mail Web Search Protocom Partner/Reseller Novell Presentation Novell Consultant Colleague Secugen Other

If other, please specify:

Are you an existing Novell Worldwide Licensing Program Customer? If so, which agreement do you hold? Select an option... No agreement held VLA CLA MLA SLA ALA Other

Are you interested in discussing these solutions in more detail? Yes I'm already working with a Novell contact. Please provide their name:

How many employees work in your entire organization? Make a Selection Less than 100 Employees 100 to 499 Employees 500 to 1,999 Employees 2,000 to 4,999 Employees 5,000 to 9,999 Employees 10,000 to 49,999 Employees 50,000+ Employees Home User

What is your company's industry? Make a Selection Education Financial Services/Insurance Government - Federal Government - State & Local Healthcare IT/Hightech Manufacturing Media/Telecommunications Other Professional Business Services Retail Travel/Transport/Logisitics

What is your current relationship with Novell? Make a Selection Current Customer Potential Customer Current Partner Potential Partner Home User None of the above

What is your primary area of interest? Make a Selection Collaboration Linux Operating Systems Identity, Security & Access Management System & Resource Management Training Services Technical Support Consulting Services

What are your current requirements/requests of Novell? Make a Selection More Information Sales Call Request Technical Support Training Request None of the Above

Thanks. You are now ready to submit your information.