Agent Application

PLEASE TELL US ABOUT YOURSELF:

* NOTE: All fields should be filled in for an application to be submitted. If no information is available for a field please type in “NA”. Do not put any type of hyperlink or ad in any part of this form.

First Name: *
Last Name: *
Company: *
Email: *
Phone: *
  
Address: *
City: *
State / Province: *
Zip Code: *
Who referred you or how did you hear about us?
 
If other, please specify:
 
What carriers, if any, are you directly contracted with? *
What carriers, if any, are you indirectly writing business with? *
What is your experience in the telecommunications industry? *
How would you describe your role in the telecom channel?
(VAR, Ex-Carrier Rep, Equipment Vendor, Telecom Consultant, Master Agent, etc.) *
What products and services do you sell?
(Voice, Data, etc.) *
Do you sell equipment and if so who are you certified with?
(Cisco, Avaya, Shoretel, etc) *
How many circuits do you sell and/or how much revenue do you generate per month? *
How much does your telecom base bill on a monthly basis? *
Are you interested in offering mobility services to your clients? *
      Yes
      Maybe
      No
 
What mobility solutions do you offer? *
Why would you like to be an agent with WTG? *
Are you interested in offering energy services to your clients?
(Electricity, Gas, DSM) *
      Yes
      Maybe
      No
 
What is 0 + 0? *