Partner Application
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Company Information
Company Name
Address
City
State
Zip/Postal Code
Contact Information
Contact Name
Principal/Title
E-mail
Business Phone
Fax Number
Business Information
Telecom Industry
# Years
Independent Agent
# Years
Number of Sales Representatives
Number of accounts in existing base
Monthly billing in existing base
Base Distribution
Voice%
Data %
Average New Sales (Monthly) $
Currently Selling
(Check ALL that apply)
Voice
LD Switched
LD Dedicated
Local
Calling Cards
Teleconferencing
Data
DSL
Frame Relay
Dedicated IP
Equipment
VoIP
Other
IP VPN
Private Line
Target Market
Geographic Areas
Industries
Customer Type(s)
Market Size
Estimate Your Monthly Sales Forecast with TCO
6th Month
12th Month
24th Month
Do you currently represent other carriers?
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