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End User Deal Registration
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Linksys Partner Advantage

End User Deal Registration Form

* Required Fields

Reseller Information

*Are you a registered Belkin/Linksys Authorized Reseller?

Yes	No * Required.

* Please note you must be an authorized reseller in order to register a deal. If you are not an existing Belkin/Linksys reseller, please register here.

*Reseller Name:: * Required.

*First Name (Sales Person):: * Required.

*Last Name (Sales Person):: * Required.

*Address:: * Required.

*City:: * Required.

*Country:

*State:: State is a required field.

*Zip Code:: Zip is a required field.

Primary Phone:

Extension:

*Email: Email is a required field.
Email id is invalid.

Distributor

Distributor:

Brightstar

D&H

Ingram Micro

Petra

S.P. Richards

Synnex

Tech Data

Prospect (End User) Information

*Company Name:: * Required.

Primary Contact:

Primary Contact Title:

Email:: Email id is invalid.

Address:

City:

Country

State: State is a required field.

*Zip Code: Zip is a required field.

Primary Phone

Extension:

Summary of Reseller History with Account:

Description of Environment

*Estimated Close Date (mm/dd/yyyy):: * Required.

*Est. $ Value of Configuration:

$1 - $4,999

$5,000 - $10,000

$10,001 - $15,000

$15,001 - $20,000

$20,001 +

* Required.

Description of competitive environment in the account:

Description of solution being proposed:

Alternate solutions being considered by the customer:

Products to be part of registered deal

*Select the products and quantities:

Part Number	Quantity

[+] Add more rows

Additional Notes:

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