Partner Application
Primary Contact and Company Information
First Name: *
Last Name: *
Title:
Email: *
Phone: *
Fax:
Company: *
Address: *
(2):
City: *
State: *
Zip Code: *
Country:
Website:
Main Phone:
Main Fax:
Type of Company:
Reseller Candidate Information
Do you currently resell telecommunications (Voice and/or Data) services either on behalf of a telecom carrier or do you currently sell your own telecommunication service; What vendors?:
Qwest
AT&T
Sprint
MCI
Bellsouth
Self-Provided
Verizon
SBC
Megapath
Global Crossing
Covad
Other
None
General Comments:
Do you currently resell telecom hardware including PBXs, key systems or routers?:
Cisco
Nortel
Avaya
NEC
Mitel
Lucent
Juniper
Other
None
General Comments:
Do you provide customer billing service?:
Do you provide usage based billing service?:
If so, how many billing personnel do you have?:
What is your approximate gross sales?:
What year was your company established?:
What services are you interested in reselling?:
Hosted PBX Service
Enhanced Local Service or PRI replacement
MPLS IP VPN Solutions
Co-Location Services
Private Line Services
Dedicated Internet Service
Dark Fiber
Metro Fiber
Do you have an active sales force?:
If so, how many?:
Do you currently sell ...:
Local
Regional
National
International
How did you hear about the Centric-PARTNER Program?:
General Comments:

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