Registration

Please use English Characters only when completing registration.

Agree to Terms

I agree to terms and conditions: *

My company (and if applicable my Siemens Distributor) approve me to register for this program: *

Partner Details

First Name: *

Last Name: *

Work Email: * This email will be your username and can only be updated by contacting support@siswpartnerrewards.com!

Work Phone: *

Siemens Webkey: *

Country: *

Address 1: * (Must provide full and accurate shipping address.)

Address 2

City: *

State: *

Province/Territory: *

State/Province/Territory: *

Zip: *

Social Security Number / Social Insurance Number: *

Company Name: *

Job Title: *

Role: *

Function:

% Time Spent Representing Siemens:

Siemens Products you Focus on (select all products that apply)

Manager First Name: *

Manager Last Name: *

Manager Email: *

Siemens' Distributor Approving Tier 2 Partner Participation (if applicable):