Become a Vivotek Channel Partner - Submission Form

BECOME A PARTNER

Partner Details:
Company Name:*
Phone:*
Fax:
Website:*
Country:*
Street Address:*
City:*
State/Province:*
Zip/Postal Code:*
Industries:*
Company Size:
Business Type:*
Quarterly Revenue Commitment (MSRP):*
Vivotek Authorized Distributors:* (Which VIVOTEK distributors are you working with?
Distributor Account Number:* (Must enter the correct account numbers in order to receive partner discount)
Primary Contacts:
Email:*
Salutation:
First Name:*
Last Name:*
Job Title:*
Phone:*

DWG - 800 Shames Drive , Westbury , NY 11590 , USA - 516-933-4900

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