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Callcentric Agent Program Application
 
Agent Program Please complete the following form to apply to become a Callcentric Agent.
Please fill in all fields on the form. We need this information to calculate your commission.

CALLCENTRIC ACCOUNT CREDENTIALS
 
Username *:
Password *:
You must have a Callcentric account to complete the Agent Program Application. You can create an account here and then come back to this page and submit this form.

CONTACT INFORMATION
 
Title *:
First Name *:
Last Name *:
Company Name:
Position:
Telephone *:
Email *:
Address 1 *:
Address 2:
Address 3:
City *:
State *:
Zip/Postal Code *:
Country *:

QUESTIONS
 
Please describe any businesses you are involved in today (check all that apply):
Calling cards reseller
Call shop
Broadband phone services reseller
Equipment reseller
Wholesale telecom
Other telecommunications services:
Where do you plan to advertise/promote the Callcentric service *?
Geographical areas (Countries, Regions, Cities)
Internet websites (please list sites)
Any specific ethnic groups
Other
How will you promote the service? (check all that apply) *:
Word of mouth
Internet advertising
Sales people
Newspaper/magazine
Other (please describe):
How involved do you plan to be in setting up and helping your customers? (check all that apply) *:
I will place a link on my website
I will setup, maintain and support my customers
I will help my customers that do not have credit cards with payments
I will create and maintain my customers accounts by myself
Other:
Please provide customer projections as to the number of paid subscribers (any rate plan other than IP Freedom) you believe you will have at the following intervals:
1 month
2 month
6 month
1 year

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