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In order for Tellabs to respond to your request as fast and effectively as possible, please fill out as many fields as possible. Fields marked with an * are required.



Where did you hear about Tellabs?
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Other:
 
Primary Contact:
 
First Name:*
Last Name:*
Job Title:*
Phone:*
Fax:*
E-mail:*
 
Company Information:
 
Company Name:*
Division:
Address:*  (No PO Box)
Address 2:
City:*
State/Province:*
Zip/Postal:*
Country:*
Phone:*
Fax:*
Website:*
 
Year Established:*
Tax ID Number:
DUNS Number:*
Legal Structure:*
Is your company publicly traded?:*
Number of Employees:*
Annual Revenue:*
Gross Sales YTD:*
 
Gross Sales for the Past Three Years *
2011:
2010:
2009:
 
Company Affiliations:
 
Is your company a subsidiary of a parent company?:* 
If yes, what is the name of the parent company?: 
If yes, what is the primary business of the parent company?: 
 
Does your company have any subsidiaries or affiliates?:* 
 
If yes, please include the following information for each subsidiary or affiliate.
 
Company:
Address:
City:
State:
Zip/Postal:
Country:
Contact:
Phone:
Fax:
 
Company:
Address:
City:
State:
Zip/Postal:
Country:
Contact:
Phone:
Fax:
 
Company:
Address:
City:
State:
Zip/Postal:
Country:
Contact:
Phone:
Fax:
 
Company:
Address:
City:
State:
Zip/Postal:
Country:
Contact:
Phone:
Fax:
 
Products/Services:
 
Type of Business:*
Other:
 
Standard Industrial Classification (SIC) Codes:
 
Code No. 1* Code No. 2 Code No. 3 Code No. 4 Code No. 5
 
North American Industry Classification System (NAICS) Codes:
 
Code No. 1* Code No. 2 Code No. 3 Code No. 4 Code No. 5
 
Geographic Service Areas:
 
Local:*  If yes, specify:
Regional:*  If yes, specify:
National:*  If yes, specify:
International:*  If yes, specify:
 
Certifications:
 
Is your company a Minority Business Enterprise?:* 
 
Is your company a Small Business Concern,
pursuant to Section 3 of the Small Business Act (SBA)?:* 
 
Diversity Certification:*  Gender:* 
Certifying Agency 1:*  Expires:*   
Certifying Agency 2:  Expires:   
Certifying Agency 3:  Expires:   
 
SBA Certification:*  Expires:*   
 
Other Certification 1:  Expires:   
Other Certification 2:  Expires:   
 
Quality Certifications:*
Other:
 
Tellabs Relationship:
 
Has your company done any business with Tellabs?:* 
If yes, please provide the following:
 
Entity/Department:
Location(s):
Agreement Type:
Agreement Number:
Status:
Start Date:
Expiration Date:
Products/Services Provided:
 
Revenue Associated with Product/Services Provided:
 
Current Year Estimated:
Prior Year Total:
 
Tellabs Contact Name(s):
 
References (Major Customers):
 
Company Name:*
Contact:*
Phone:*
Products/Services Sold:*
 
Company Name:*
Contact:*
Phone:*
Products/Services Sold:*
 
Company Name:
Contact:
Phone:
Products/Services Sold: