Partner Prospect Registration Form

(Please click SUBMIT when finished)

Cognitient Corp. partners must complete this form to request registration of sales opportunities prior to a pursuit. The registration process is designed to avoid multiple partners competing for the same opportunity. Cognitient Corp. will evaluate each request and respond via email to the partner contact who manages the Cognitient relationship. Incomplete registration forms will extend processing time.

Partner #*

If Partner # is unknown, or not listed, select "Other," complete the rest of the form and send an email indicating both the Partner and Prospect names to partner@cognitient.com

Partner Name*

Partner Role*

Please select your role in this pursuit

Requested by*

First Last

Email Address of Requester*

Prospect Business/Organization Name*

Prospect Industry*

Please select the industry that most accurately describes the business unit

Prospect Annual Revenue*

Accurate prospect revenue is needed for pricing

Please enter a number greater than or equal to 1000000.00.

Name of Sponsoring Executive*

First Last

Title of Sponsoring Executive*

Business Unit Name*

Please provide the business unit name of the sponsoring executive

Business Unit Function*

Please select the business function that most closely describes the business unit

Project/Initiative Name*

Please provide the name used by the prospect's business/organization to describe the project/initiative

Sales Cycle Phase*

Next Step*

How Customer Was Identified*

Cognitient Models For This Project/Initiative*

Please multi-select (CTRL+CLICK) each analytic model required to address this project/initiative.

Hidden

Cognitient Offering(s)

Please indicate each analytic model you are selling to address this project/initiative

Estimated Close Date*

Location Nickname*

Please provide the nickname commonly used within the prospect's business/organization to describe this location

Location Address*

Street Address Address Line 2 City State ZIP Code

Consent*

I agree to the privacy policy.

By clicking the checkbox below you confirm you've read and accept the Cognitient Privacy Policy which can be viewed by clicking the URL immediately below this text. *

www.cognitient.com

Notes and Comments

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Partner Prospect Registration Form

(Please click SUBMIT when finished)

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