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| No P.O. Boxes please. Fill-in all blanks. Please print clearly. |
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Check One: Agent Reseller: _________ Agent Referral __________
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Company Name:________________________________________________DBA: _________________________
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Federal Tax ID:____________________________: or Social Security#:___________ ______________________
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Dun & Bradstreet#:___________________________________________________________________________
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Company Address:___________________________________________________________________________
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City/St/Zip:___________________________________________________________________________________
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Toll-free:___________________________________________________________________________________
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Billing Address:_______________________________________________________________________________
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Company Phone:__________________________________________________________________________
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Company Fax:_____________________________________________________________________________
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Company Email:__________________________________________________________________________
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Sales Contact: ___________________________________________________________________________
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Sales Phone: _____________________________________________________________________________
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Sales Email: ______________________________________________________________________________-
(Company email addresses only. We do not accept Yahoo, MSN, or other personal email addresses.)
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| Business & Marketing Profile |
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Years Established:_________________________________________________________________________
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Gross Annual Sales:___________________________________________________________________
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Number of Locations:____________________________________________________________________
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Number of employees:____________________________________________________________________
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Do you sell telecom products now? If yes, what type: ___________________________________________
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What is your product focus? Voice Communications: ___________________________ Data: _____________
Wireless: ___________________________________________Other: __________________________________
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You agree not to advertise Masterline Messaging Communications products on the Internet
for anything less than MAP* (Minimum Advertised Price) or MSRP.
Failure to adhere to this agreement will immediately exclude you from selling Masterline
Messaging Communications products.
Signature
The statements provided in this application and in the attached documents are true and complete
to the best of my knowledge. I also understand that information submitted in this application will
be treated discreetly by Masterline and that my providing inaccurate and/or false information
may be grounds for Masterline to terminate any future business arrangements.
Name (print): ___________________________________________________Date: ______________________
Signature: _________________________________________Title (print): ______________________________
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Masterline Technologies reserves the right to decline or remove an agent from the program at its own discretion.
