nitrodr.synnexcloud.com.au Open in urlscan Pro
49.156.27.142  Public Scan

Form analysis
1 forms found in the DOM

Name: quotefrm1 — POST

<form name="quotefrm1" id="quotefrm1" method="post" action="" novalidate="novalidate">
  <h2 class="sec-tit notpadd">Information about You</h2>
  <div class="row">
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-left">
      <div class="form-group">
        <input type="text" name="your_name" id="your_name" class="form-control required">
        <label>Your Name<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-left">
      <div class="form-group">
        <input type="text" name="reseller_name" id="reseller_name" class="form-control required">
        <label>Reseller Name<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="email" name="email" id="email" class="form-control required email">
        <label>Your Email<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="your_phone" id="your_phone" class="form-control required">
        <label>Your Phone<span>*</span></label>
      </div>
    </div>
  </div>
  <div class="clear"></div>
  <div class="row">
    <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 pull-right">
      <label class="label2">Your Location</label>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="your_city" id="your_city" class="form-control required">
        <label>City<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="your_state" id="your_state" class="form-control required">
        <label>State/Province/Region<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="your_country" id="your_country" class="form-control required">
        <label>Your Country<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="distribution_partner" id="distribution_partner" class="form-control required">
        <label>Distribution Partner<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="synnex_cust_code" id="synnex_cust_code" class="form-control required">
        <label>Synnex Customer Code<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group form-group2">
        <input type="hidden" name="dr_reference_number" id="dr_reference_number" class="form-control" value="1" readonly="">
        <label>DR Reference number <span>*</span></label>
      </div>
    </div>
  </div>
  <h2 class="sec-tit">Your Opportunity</h2>
  <div class="row">
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="customer_name" id="customer_name" class="form-control required">
        <label>Customer Name<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="contact_name" id="contact_name" class="form-control required">
        <label>Contact Name<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="contact_title" id="contact_title" class="form-control required">
        <label>Contact Title<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="employee" id="employee" class="form-control required">
        <label># of Employees<span>*</span></label>
      </div>
    </div>
  </div>
  <div class="clear"></div>
  <div class="row">
    <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 pull-right">
      <label class="label2">Customer Location</label>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="customer_city" id="customer_city" class="form-control required">
        <label>City<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="customer_state" id="customer_state" class="form-control required">
        <label>State/Province/Region<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="customer_country" id="customer_country" class="form-control required">
        <label>Customer Country<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <select name="industry" id="industry" class="form-control required">
          <option value=""></option>
          <option value="Architecture/Engineering/Construction">Architecture/Engineering/Construction</option>
          <option value="Business Services">Business Services</option>
          <option value="Eductaion">Eductaion</option>
          <option value="Finance/Banking">Finance/Banking</option>
          <option value="Government">Government</option>
          <option value="Helthcare">Helthcare</option>
          <option value="Insurance">Insurance</option>
          <option value="IT">IT</option>
          <option value="Legal">Legal</option>
          <option value="Menufacturing/Prduction">Menufacturing/Prduction</option>
          <option value="Marketing/Advertising">Marketing/Advertising</option>
          <option value="Non-Profit">Non-Profit</option>
          <option value="Personal Use">Personal Use</option>
          <option value="Pharmaceutical/Biotech">Pharmaceutical/Biotech</option>
          <option value="Real Estate">Real Estate</option>
          <option value="Retail">Retail</option>
          <option value="Utilities">Utilities</option>
          <option value="Other">Other</option>
        </select>
        <label>Industry<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <select name="rfp" id="rfp" class="form-control">
          <option value=""></option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <label>Going to RFP?</label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <select name="contact_role_opportunity" id="contact_role_opportunity" class="form-control">
          <option value=""></option>
          <option value="Decision Maker">Decision Maker</option>
          <option value="Influencer">Influencer</option>
        </select>
        <label>Contact Role in opportunity<span>*</span></label>
      </div>
    </div>
  </div>
  <h2 class="sec-tit">Their Productivity Usage</h2>
  <div class="row">
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="current_pdf_vendor" id="current_pdf_vendor" class="form-control required">
        <label>Current PDF vendor<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="licenses" id="licenses" class="form-control required">
        <label># of licenses<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <input type="text" name="expiration_date" id="expiration_date" class="form-control required hasDatepicker">
        <label>Expiration Date<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <select name="budget_availability" id="budget_availability" class="form-control required">
          <option value=""></option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <label>Budget Availability?<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <select name="nitro_presented" id="nitro_presented" class="form-control required">
          <option value=""></option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <label>Nitro presented?<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right">
      <div class="form-group">
        <select name="meeting_set_up" id="meeting_set_up" class="form-control required">
          <option value=""></option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <label>Meeting set up?<span>*</span></label>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right" id="shwwhendate">
      <div class="form-group">
        <input type="text" name="when_date" id="when_date" class="form-control required hasDatepicker">
        <label>If so when…?<span>*</span></label>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12 pull-right textarea-fld full-width">
      <div class="form-group">
        <textarea name="notes" id="notes" class="form-control"></textarea>
        <label class="full-label">Notes</label>
      </div>
    </div>
  </div>
  <div class="clear"></div>
  <div class="row">
    <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 pull-left text-center">
      <input value="submit" class="btn" type="submit" id="submit">
    </div>
  </div>
</form>

Text Content

DEAL REGISTRATION FORM


INFORMATION ABOUT YOU

Your Name*
Reseller Name*
Your Email*
Your Phone*

Your Location
City*
State/Province/Region*
Your Country*
Distribution Partner*
Synnex Customer Code*
DR Reference number *


YOUR OPPORTUNITY

Customer Name*
Contact Name*
Contact Title*
# of Employees*

Customer Location
City*
State/Province/Region*
Customer Country*
Architecture/Engineering/Construction Business Services Eductaion
Finance/Banking Government Helthcare Insurance IT Legal Menufacturing/Prduction
Marketing/Advertising Non-Profit Personal Use Pharmaceutical/Biotech Real Estate
Retail Utilities Other Industry*
Yes No Going to RFP?
Decision Maker Influencer Contact Role in opportunity*


THEIR PRODUCTIVITY USAGE

Current PDF vendor*
# of licenses*
Expiration Date*
Yes No Budget Availability?*
Yes No Nitro presented?*
Yes No Meeting set up?*
If so when…?*
Notes




DEAL REGISTRATION T&CS

 * Submitting reseller representative has completed and passed their Nitro
   product training (when available)
 * Opportunity minimum 50 licenses
 * Partner must be in good standing with Nitro
 * Partner must have active agreement with Nitro
 * Partner must set up a call with customer
 * Nitro reserves the right to determine additional margin applicability on
   special priced deals
 * Approved registration is good for 180 days and may be considered for an
   extension if certain behaviours are met
 * Discount available to all eligible Nitro resellers, available through Synnex
   Australia Pty Ltd
 * Nitro and Synnex reserves the right to determine margin applicability on an
   opportunity by opportunity basis

Copyright © 2023 Synnex All Rights Reserved.