AT&T Powerfleet Qualification Form

Customer Qualification Form
Your AT&T Business Unit*
Retail Store Name*
Retail Store Location*
City, State
AT&T Information
Retail Comp Code*
AT&T Alliance Solution Provider*
Is the client information part of the 'Fleet In Focus' campaign?*

YesNo
CampaignID
Your Name*

First NameLast Name
Your Phone Number
Please enter a valid phone number.
Your email address*
example@att.com
Billing Channel

Carrier - AT&T US
Please select your Powerfleet Regional Sales Manager (RSM)*
Would you like to schedule a meeting with your RSM?

YesNo
Customer Information
Is the customer an existing Powerfleet customer?*

YesNo
Have you previously completed a qualification form for this customer?

NoYes
OwnerID
Business Name*
Contact's Title
Business title or role
Customer Contact Name*

First NameLast Name
Customer's Email Address*
example@example.com
Customer's Phone Number*
Industry
Primary Business Location - City*

Street Address

Street Address Line 2

Zip Code
‎Primary Business Location - State*
StateCode
Fleet Information
How many vehicles does the business own?*
What type of vehicles does the business own?

Light Duty (cars, pickup trucks, vans, flat beds)Heavy Duty (18 wheelers, box trucks, dump trucks)FordGMOther
How many of the mobile assets (not vehicles) could potentially benefit from tracking?*
What type of mobile assets does the business own?

TrailersContainersSpecialty (ATVs, forklifts, "yellow iron", etc.)GeneratorsNot applicableOther
Does the business currently use a fleet telematics provider?

YesNo
Who is the current fleet telematics provider?
Does the business currently deploy a dash camera solution on their vehicles?

YesNo
Vehicles+assets
Additional information you would like to share*
Additional information
LeadSource
Should be Empty:

Customer Qualification Form

AT&T Information

Customer Information

Fleet Information