Title/Communication Topic
(23pt/26pt)

 

 
Customer Information    
Educational Institution: *
 City:*
State/Province:*
Address:* Postal Code:*
End User Email:*
Country:* End User Phone:*
       
Technical Contact      
First Name:* Phone (+ext):*
Last Name:* Country:*
Email Address:* State/Province:*
Address:*   City:*
Postal Code:*
     
Training/Curriculum Coordinator Last Name:*
First Name:* Email Address:*
       
Channel Information      
Purchase Order Number: * State/Province:*
Reseller Name:* Country:*
Sales Person:* Postal Code:*
Channel Address:* Sales Person's Email:*
City:* Channel Phone:*
       
Purchase Discount Worksheet    
Product Category: Total Purchase Price:
Products:   Do you want to add another product to your list?
Quantity:   Yes No  
       
Additional Information    
Type of institution:   Polycom Channel Manager Contact:
Polycom Territory Manager Email:
       

• Channel Partner must submit a NEW purchase order and claim form to Polycom Order Management with copies of the completed Honors application Form.
• Click the Submit form below to enable your customers to receive the many complimentary Honors Program benefits (training, memberships, etc.).

To save a copy of this form for your records.  Please Print prior to submitting registration form.

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