Partner Name*
Partner Reference ID
Sub Agent Var Name
Requestor Name*
Requestor Email*
Opportunity Type* Sell Alone Co-Sell Partner Led Co-Sell Direct Led Resale TBD
USCC Direct Assoc Name for Co-Sell* If unknown at this time, enter "Unknown" for Direct Associate Name.
Business Name*
Address*
City*
State*
Zip Code* Please enter the 5-digit zip code. No dashes or special characters.
Will the service primarily be used in a UScellular market?* Yes No Click here to view our coverage map
Contact First Name
Contact Last Name
Contact Email
Contact Phone Please enter phone number with numbers only (no dashes, parentheses, spaces)
Existing Uscellular Customer* Yes No Unknown
Customer ID
Opportunity Size (# of lines)*
Estimated Close Date* January February March April May June July August September October November December
Device/Solution Type Smartphone Tablet Feature Phone Connected Device IoT - M2M IoT – M2M – With Static IP Wireless Modem
Device Purchase Type EIP BYOD Subsidy
Device/Solution Use Case
Other Pertinent Opportunity Notes to Consider
Comments
