Portal Order Form

Partner & Contact Information

Your Company Name:

Primary Contact Name on Account:

Your Phone Number:

Your Email (required)

Carrier Channel Manager Name:

Portal Information

Customer Name:

Customer Home URL:

Select Carrier(s) the portal will have:
 Sprint Nextel AT&T

Fill out next 12 questions only if needed

Sprint Corporate Liable % discount:

Sprint Corporate Root NODE:

Sprint Employee Liable % discount::

Sprint Employee Liable % discount::

Nextel Corporate Liable % discount:

Nextel Corporate Root NODE:

Nextel Employee Liable % discount::

Nextel Employee Liable % discount::

ATT Corporate Liable % discount:

ATT Corporate Root NODE:

ATT Employee Liable % discount::

ATT Employee Liable % discount::

Flat Rate pricing for Corporate Liable:

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 URL: (i.e. www.sprint.com/customer_name):

Special promotions or pricing:

Notifications

Is Order Experts handling your fulfillment?

Is Order Experts handling your calls?

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

Please type additional comments here:

Logos

Logo One:

Logo Two:

Logo Three: