Deal Registration Form

This form is only to be used by existing Virtual Badge resellers.
* Required Fields

*Reseller Name:

*First Name (Sales Person):

*Last Name (Sales Person):

Primary Phone:


*Company Name (Prospect):

Primary Contact:

*Email (Prospect):

*Zip Code

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

*Est. $ Value of Configuration:

*Package(s) to be part of registered deal

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