Affiliate-Reseller Application

    

MEDIASOURCEŽ V-MAIL AFFILIATE and RESELLER APPLICATION
We are looking for a few key affiliates and resellers to market and reap the benefit of this Break-a-way Technology sevice. If you have marketing and some technical skills and are interested in becoming part of this truly ground floor opportunity, please tell us about yourself on the form below. We will get back to you by email with our response.
First Name
Last Name
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Country
Daytime Phone() -
Fax() -
E-mail Address
Your Internet Provider:
Your Website URL:
Comments
Size of Your Market Area
How Long in Business
What Products or Services do you now offer?
Products and Services
Tell us Something about your business
Other Affiliations

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