Partner Deal Registration

PARTNER/DISTRIBUTOR DETAILS

Reseller Name*

Account Manager's First Name*	Account Manager's Last Name*


Account Manager's Email Address*

Account Manager's Phone Number*

Distributor Contact First Name	Distributor Contact Last Name


Distributor Contact Email Address

END USER CUSTOMER DETAILS

Company Name*

Street*


City*	State*


Postal Code*	Country*

First Name*	Last Name*


Email Address*

Customer Contact Number

OPPORTUNITY DETAILS

Are you engaged with a Gluware Sales Resource?*

Yes

Gluware Rep First Name	Gluware Rep Last Name

Please provide a brief description of the opportunity with as much information as you may have, e.g. Config Modeling, Config Drift, OS Upgrade, number of network devices, network equipment manufacturer and type (router, switch, firewall etc.). Limit to 500 characters.

Expected Close Date *