Deal Registration Form

Customer Name

Customer Contact Name

Suzy Smith

Customer Contact Title

Title

Customer Contact Telephone Number

000-000-0000

Customer Contact Email Address

email@email.com

Customer City

City Name

Customer State/Province

North Carolina

Customer Country

United States

Account Vertical

Partner

Partner Name

Preferred Distributor

Name of User Submission

John Doe

Email of User Submission

email@email.com

Partner Opportunity Owner Name

John Doe

Partner Opportunity Owner Email Address

John Doe

Partner Opportunity Owner Phone Number

000-000-0000

Product Family 1

Product Family

Quantity 1

2

Product Family 2

Product Family

Quantity 2

2

Product Family 3

Product Family

Quantity 3

2

Product Family 4

Product Family

Quantity 4

2

Product Family 5

Product Family

Quantity 5

2

Total Value of Opportunity (USD)

$2,000

RFP / RFQ Expected?

Yes

Estimated Services Type

Service Type

Anticipated Close Date

00/00/0000

Opportunity Details

Here are where the details are listed

Lead Source

Date / Time of Form Submission

00/00/0000

Estimated Delivery Date

00/00/0000

Channel Account Manager

Account Manager Name

By submitting a Toshiba Deal Registration Request Form, Business Partner accepts and agrees to the Deal Registration Terms and Conditions, as they may be periodically amended.