Agent Partner Application

Primary Contact:
Company Name:
Address:
Unit/Suite:
City:
State:
Zip:


Telephone Number:
Mobile Number:
Fax Number:
Email Address:
Website Address:


How did you hear about us? Magazine/ Newspaper Tradeshow TA Association An Agent Internet Search Engine (Google, Excite, etc.) Other

Briefly describe your company and how you plan to integrate PNG products into your marketing plan.

Have you sold long distance or other communications services before? No Yes

What services will you be selling? Voice Only Voice & Data Data Only

How much NEW revenue does your company generate monthly?

What telecom products are you currently marketing?

What PowerNet Global products is your company interested in? Switched Long Distance (1+, 800, Calling Cards) Dedicated Long Distance Wholesale Long Distance International Long Distance Dial-Up Internet Access Dedicated Internet Access Wholesale Internet Access Integrated Access Data Products MPLS Local Service Dedicated Local Voice Over Broadband

Thank you for your interest in becoming an agent with PowerNet Global Communications.