* The offer is exclusive to Vericom Certified Installers and Distribution Partners. Please read the full terms and conditions of the promotion before participating.

Please complete the form below to let us know your interest in participating in this promotion. Our team will follow up with you to provide all the details and assist you with placing a qualifying order to earn your free patch panel(s).

Your First Name: Ex. John

Your Last Name: Ex. Smith

Your Company Name: Ex. ABC Supply Company

Your Job Title: Ex. Sales Manager

Your Company Email Address: Ex. john.smith@abcsupply.com

Your Phone Number: Ex. (123) 456-7890 x123

Are You A Vericom Certified Installer Or Distribution Partner: I'm A Vericom Certified Installer I'm A Vericom Distribution Partner Please select either 'I'm A Vericom Certified Installer' or 'I'm A Vericom Distribution Partner.' If you are neither, please return to the previous page and click the 'I'm NOT a Vericom Certified Installer or Distribution Partner' button to complete the appropriate form.

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