Avaya Partner Registration Form
PLEASE COMPLETE THE APPLICATION IN ENGLISH
PLEASE ENSURE THAT YOU COMPLETE ALL THE REQUIRED FIELDS AND CHECK THE “ACCEPT T’s AND C’s” BOX AT THE BOTTOM OF THIS PAGE TO ENSURE YOUR APPLICATION IS PROPERLY SUBMITTED. THANK YOU
Account Details
Partner's Account Name
Doing Business Name/Trading As
Address Line 1
Company Tax ID/ VAT
Address Line 2
Chamber of Commerce/Company ID
Address Line 3
Parent Company Name
City
State
Country
Year of Incorporation
Post/Zip Code
Place of Incorporation
Phone (Include Country Code)
Company URL
Have you ever been a reseller with Avaya?
Have you been recruited [Asked to Join Avaya] by a Distributor or an Avaya Representative?
Neither
Distributor
Avaya Representative
Distributor Name
Are you working with an Avaya Channel Manager?
Channel Manager Name
Agrees to be in Partner Finder?
Contacts
Salutation
First Name
Last Name
Phone (Include Country Code)
Email
Primary Contact
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
|
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Technical/Support Contact
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
|
|
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Business Development Manager
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
Sales Lead
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
PRM Administrator
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
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Partner Details
No. of Employees (Total)
--None--
< 20
21-99
100 - 499
500 - 999
1000 +
1-249
>250
0 - 249
250 - 999
1,000 - 4,999
5,000 - 19,999
20,000+
No. of Sales Employees
No. of Post-Sales Support (Total)
No. of Marketing Employees
No. of Pre-Sales Support (Total)
Partner Coverage
Target Market Segment
Enterprise/Large Business
Small & Medium Enterprise (SME)
Enterprise/Large Business
Small & Medium Enterprise (SME)
Avaya Portfolio you intend to sell/deliver
Video
Voice: Enterprise
Voice: SME
Data
Services
Video
Voice: Enterprise
Voice: SME
Data
Services
Please attach your Sales and / or Marketing Plans for the portfolio you wish to sell
(Type the path of the file or click Browse button to find the file)
Enterprise Revenue Target Yr 1 (USD)
SME Revenue Target Yr 1 (USD)
Vertical Market
All
Banking
Finance
Government - Federal
Government - State & Local
Healthcare
Higher Education
Homeland Security
Hospitality
Insurance
Legal
Manufacturing
Retail
Telecommunications
Transportation
Utilities
All
Banking
Finance
Government - Federal
Government - State & Local
Healthcare
Higher Education
Homeland Security
Hospitality
Insurance
Legal
Manufacturing
Retail
Telecommunications
Transportation
Utilities
Other Vendor Relationships
No Existing Vendor
Cisco
Nortel
Alcatel- Lucent
Siemens
NEC
3Com
Active Voice Corp
Altitude
Avaya (Direct/Partner)
ASPECT
Bea Systems
British Telecom
Ericsson
Fujitsu
Genesys
Hitachi
Huawei
IBM
Intervoice
LG
Melita
Microsoft
Mitel
NTT
Panasonic
Radvision
Polycom
Rockwell
samsung
Shoretel
Toshiba
Other
Unknown
No Existing Vendor
Cisco
Nortel
Alcatel- Lucent
Siemens
NEC
3Com
Active Voice Corp
Altitude
Avaya (Direct/Partner)
ASPECT
Bea Systems
British Telecom
Ericsson
Fujitsu
Genesys
Hitachi
Huawei
IBM
Intervoice
LG
Melita
Microsoft
Mitel
NTT
Panasonic
Radvision
Polycom
Rockwell
samsung
Shoretel
Toshiba
Other
Unknown
Other Brand Certifications
Cisco
Extreme
Genesys
Juniper
Linux
Microsoft
Nice
Nortel
Oracle
PMI
Radvision
Redhat
Witness
Cisco
Extreme
Genesys
Juniper
Linux
Microsoft
Nice
Nortel
Oracle
PMI
Radvision
Redhat
Witness
Women/Minority Owned
(US Only)
Other Contacts
Salutation
First Name
Last Name
Phone (Include Country Code)
Email Address
Role
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
None
Mr.
Ms.
Mrs.
Miss.
Dr.
Prof.
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
Partner Registration Submitter
Click on this link to review T's & C's
Terms and Conditions
By checking this box, I acknowledge and represent that I have read, understood and accept the terms and conditions of this Agreement on behalf of Reseller and have the authority to bind the Reseller to the terms and conditions hereto.
Comments
Same As Primary Contact
First Name
Last Name
Phone (Include Country Code)
Role
None
Business Manager
Executive, Sales Management
Inside Sales
Marketing, Administration
Other
Primary Contract Negotiator
Principal/CEO
Project Manager
Remote Feature Activation Manager
Sales - Services
Sales - Solutions
Sales Support
Software Specialist
SOIR Contact (Distributors Only)
Solution Architect
System Engineer
Technician, Services Management
Trainer
Email