Android Zero-Touch Enrollment Request Form

Full Name

First NameMiddle NameLast Name

Work Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Company / Organization Name

Department or Team

Job Title / Role

Number of Android Devices to Enroll

Device Model or Model Name

Device OS Version (if known)

Device Inventory by Batch

Reseller / Procurement Source

Purchase Order or Reference

Purchase Date or Expected Delivery Date

Date

Purchase Status

Android zero-touch customer/account name

Zero-touch admin contact email

example@example.com

Reseller ID or partner reference

Do you already have access to the zero-touch portal?

Portal/account reference

MDM/EMM Platform

Enrollment Configuration Name

Provisioning Template / Setup Profile Name

Device Naming Convention

Wi‑Fi Required During Setup

App or Policy Assignment Notes

Deployment Location Country

Shipping Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Desired Go-Live Date

Date

Deployment Type

Special Handling or Deployment Instructions