Agent Partner Contact Info
Business Name
*
Address1
*
Primary Contact
*
Address2
Primary Business
*
Select One
Call Center
Door 2 Door
Retailer
Online Marketing
City
*
Telephone Number
*
State
*
Select a state
Alaska
American Samoa
Arizona
Arkansas
California
Canal Zone
Colorado
Canal Zone
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Trust Territories
U.S. Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alternate Number
Zip Code
*
Email Address
*
Product
*
Who reffered you?
*
How many years have you been in business?
*
Select One
new business
1-2 years
2-3 years
4-5 years
6+
How many locations do you have?
*
How many activations does your company produce monthly for your other carriers?
*
How many employees in your organization?
*
How much of your clientel speaks Spanish?
*
Select One
less than 20%
20-50%
greater than 50%
What markets do you operate in?
*
What carriers services do you currently sell?
*
How did you hear about Direct Communications?
*
Google
Yahoo
Bing
other
What keywords did you use when searching?
*
How will you plan to market these products?
*
Please explain how you will achieve the 30/60/90 day sales projections?
*
Have you been terminated by another carrier before?
Yes
No
If yes explain:
What is your marketing budget?
*
Direct Communication Sales Contact
Dealer Services
sales@directcommunications.us
Employment Opportunities
jobs@directcommunications.us
Partner With Us
newpartners@directcommunications.us
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