Please fill out the following fields and click the 'Submit' button once to forward portal information.

Please do not use hyphens or dashes when entering phone numbers.

* = Required Field

Partner & Contact Information

Your Company Name:
Primary Contact Name on Account:
Contact Name Phone:
Contact Name Email:
Carrier Channel Manager Name:
Signed re-seller agreement with the carrier?	Choose One Yes No

Portal Information

Customer Name:
Customer Home URL:
Select Carrier(s) the portal will have:	Sprint Nextel AT&T
Flat Rate pricing for Corporate Liable:	Choose One Yes No

Marketing

If portal should be limited to specific phones, please list them:
Specify custom text on landing page (if any):
Portal URL:   (i.e. www.orderexperts.com/customer_name)
Sprint vanity:   (i.e. www.sprint.com/customer_name)
Special promotions or pricing:

Notifications

Is Order Experts handling your fulfillment?	Choose One Yes No Individual Liable Only
Is Order Experts handling your calls?	Choose One Yes No Individual Liable Only
Emails for Order notification:   (i.e. sales@mycompany.com)
Emails for Support notification:   (i.e. support@mycompany.com)

Portal Contact Information:

Phone number for customer sales:
Phone number for customer support:
Phone number for existing customers to receive corporate discount (usually Customer Care Number for the Carrier; leave blank, if so):
Fax number for transfers:
Phone number for Accessory Page:

Expectations:

Account team review Date: (MM/DD/YY)
Customer launch date: (MM/DD/YY)

Additional Comments:

Logos (up to 3 uploads allowed):