Channel Partner Lead Submission Form ITS Channel Partner Name* Contact Name* First Phone* Email* Prospect Company Customer Name* First Contact Name* First Phone Email* Service they are looking for Voice Solutions # Extensions # DIDs Analog Lines Yes No Toll Free #s Yes No Monthly Budget $ Electronic Fax # Fax #s # Pages/mo Is HiPAA Compliance Required? Yes No Internet Access Speed Needed Technology Preference #IPs Required Monthly Budget $ Data Security Do they have a Disaster Recovery Solution today? Yes No Do they have a back-up solution today? Yes No Monthly Budget $ Managed IT #Desktops/ Devices #Routers/Switches #Servers Monthly Budget $ Are they receiving quotes from other solutions providers?* Yes No Which providers? Attach copy? Yes No File Accepted file types: doc, docx, pdf, png, jpg, jpeg, ppt, pptx. Any other information you think would be helpful in closing the sale? Name This field is for validation purposes and should be left unchanged.