Supplier Intake Form

What is your legal company name?*

Primary contact first name?*

Primary contact last name?*

Primary contact job title?*

Primary contact email address?*

Company website?*

Type of business/services:

Does your company work with any distributors? If yes, list distributors here:*

If other, please list:

Certificate*

Please attach Certificate here.

Drag and drop files here or

What States are you certified in?*

Prior Engagement w/ C1

Current vendor / supplier

Past vendor / supplier

I do not have any prior / current engagements with C1

Other

If other, please specify:

Is there a current opportunity you are looking to partner with ConvergeOne on? If yes, please name the customer & describe the opportunity:

Send me a copy of my responses