Code Blue Corporation - Blue Alert Interconnect

Your Email(Required)

A confirmation copy of this submission will be sent to this email address.

Code Blue Order or Quote Number

Please include proper order number format of SLOR###### or SLQT######

Who will Code Blue invoice at contract renewal?(Required)

Distributor

Reseller/Integrator

End User Customer

This form is for a...(Required)

New Install

Renewal for Existing Unit

Expected Install Date

*For new services only, not applicable for service renewals. Please provide the anticipated install date for your project. Cloud Services are activated and billing commences on the date of invoice, unless otherwise approved by Code Blue.

Phone Information

Allow Inbound Calling?(Required)

No

Yes

Extensions

Row ID	Caller-ID Name (Optional)	Address	Desired Area Code (Optional)	Actions

There are no Extensions.

Primary Contact for Renewal

The first person who will be contacted in order to renew subscriptions

Renewal Contact Name(Required)

First Last

Renewal Contact Email(Required)

Renewal Contact Phone(Required)

Secondary Contact for Renewal

The second way we will try to contact you for subscription renewal. A shared inbox is preferable in case of departures from your company. Please do NOT put the same individual twice.

Renewal Contact Name(Required)

First Last

Renewal Contact Email(Required)

Renewal Contact Phone(Required)

End User Information

End User Customer Information is mandatory to provide with Managed Cloud services. If billing communications with a reseller or distributor fail (due to employee turn-over, non-response or incorrect contact information), the customer reserves the right to be contacted to prevent a lapse in their service due to non-payment.

End User Company/Organization(Required)

Owner of property where products are being installed.

End User Contact Name(Required)

First Last

End User Contact Email(Required)

End User Phone(Required)

End User Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Consent and Submit

Notes

If you provided more than one billing contact, please be sure to describe how each person is involved. For example: one entity has multiple locations and the budget is controlled by separate individuals.

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Email

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Please fill out the form below & submit it once completed to begin the process of connecting your devices to Blue Alert® Interconnect.

Phone Information

Company Information

Primary Contact for Renewal

Secondary Contact for Renewal

End User Information

Consent and Submit

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