Skip to content
(805) 480-4888
info@conectus.com
Agent Resources
MyConectUS
Digital Agent Program
CPNHub
CPNZone
Become a Partner
Sell Verizon Wireless
Sell Verizon 5G
Sell Verizon Connect
Verizon Digital Agent
Articles
Digital Agent
NASCAR
Wireless
5G Technology
IoT/M2M
Sales Training
API Intergration
Agent Resources
MyConectUS
Digital Agent Program
CPNHub
CPNZone
Become a Partner
Sell Verizon Wireless
Sell Verizon 5G
Sell Verizon Connect
Verizon Digital Agent
Articles
Digital Agent
NASCAR
Wireless
5G Technology
IoT/M2M
Sales Training
API Intergration
Linkedin
Facebook-f
Instagram
X-twitter
Youtube
Who We Are
Why Verizon Wireless
5G Business Internet
Our Leadership Team
Become a Partner
Who We Are
Why Verizon Wireless
5G Business Internet
Our Leadership Team
Become a Partner
Intelisys Sub-Agent Direct Access Request Form
Please enable JavaScript in your browser to complete this form.
Intelisys Sub-Agent Company Name
*
Intelisys Sub-Agent Company Phone Number
*
Intelisys Main Point of Contact (BDM)
*
Year Sub-Agent Company Established
*
Intelisys Sub-Agent Company Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Dun & Bradstreet D‑U‑N‑S Number
*
If you do not have a D&B number, you can obtain one here:
https://www.dnb.com/duns-number/get-a-duns.html
This is required by Verizon
Intelisys Sub-Agent Main Contact Name
*
First
Last
Intelisys Sub-Agent Main Contact Title
*
Intelisys Sub-Agent Main Contact Email
*
Intelisys Sub-Agent Main Contact Month and Day of Birth (MM/DD)
*
This is used for Verizon security and password creation
Intelisys Sub-Agent Company Stakeholder(s)
How many Principals/Owners own 20% or more of Sub-Agent’s company?
*
> Please Select
1
2
3
4
5
Company Owner 1 Name
*
First
Last
Company Owner 1 Email
*
Company Owner 1 Phone
*
Company Owner 1 - File Upload
*
Please attached a copy of a current Background Check
Company Owner 2 Name
*
First
Last
Company Owner 2 Email
*
Company Owner 2 Phone
*
Company Owner 2 - File Upload
*
Please attached a copy of a current Background Check
Company Owner 3 Name
*
First
Last
Company Owner 3 Email
*
Company Owner 3 Phone
*
Company Owner 3 - File Upload
*
Please attached a copy of a current Background Check
Company Owner 4 Name
*
First
Last
Company Owner 4 Email
*
Company Owner 4 Phone
*
Company Owner 4 - File Upload
*
Please attached a copy of a current Background Check
Company Owner 5 Name
*
First
Last
Company Owner 5 Email
*
Company Owner 5 Phone
*
Company Owner 5 - File Upload
*
Please attached a copy of a current Background Check
Submit
Scroll to Top