Taos

Partner Form

Section I: Partner Information

Rep Company Name*
Rep First Name* Rep Last Name*
 
Rep E-mail Address*
Rep Work Phone Rep Cell Phone

Section II: Lead/Customer Information

Date of 1st Contact
Contact First Name* Contact Last Name*
 
Contact E-mail Address*
Company Name* Contact Title*
 
Contact City*
Contact Work Phone Contact Cell Phone
Service Offering*
Decision Timeframe
Description/Notes