Centrify Referral Registration Form

Organizations and individuals who are not formal Centrify partners can use this form to refer a sales opportunity. For details read the Referral Program guidelines.

Note to Centrify Authorized Partners: To register deals, use the Centrify Partner Deal Registration Form instead (you will need to log in using your Centrify.com username and password).

A red asterisk () indicates a required field.

Your Contact Information

If you are submitting this deal registration on behalf of a Field Sales Representative at your organization, please enter YOUR information here and provide the first and last name of the sales rep we should work this opportunity with in the Additional Notes section of this form.

First Name:

Last Name:

Job Title:

Company Name:

Email Address:

Phone Number:

Street Address:

City:

Country:

Postal Code:

Prospect’s Contact Information

First Name:

Last Name:

Job Title:

Company Name:

Department:

Email Address:

Phone Number:

Street Address:

City:

Country:

Postal Code:

Details About the Opportunity

Tell us about the environment:

Servers:

# of UNIX servers:

# of Linux servers:

# of Windows servers:

Mac and Mobile:

# of Macs:

# of iOS devices:

# of Android devices:

SaaS and Apps:

Prospect is in process of migrating,
or planning to migrate, to Office 365:

# of SaaS Users:

List SaaS apps in use:

(e.g. Salesforce.com, Box, WebEx, NetSuite, etc.)

Additional Notes:

If you are submitting this deal registration on behalf of a Field Sales Representative at your organization, please provide their first and last name along with any other details about the opportunity.

I have read and agree to the requirements in the Referral Program description. I further understand that this opportunity registration is subject to review and approval by Centrify and that it applies to this single sales opportunity and not an "account registration."

Submit

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