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.

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.

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

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
How will you promote the service? (check all that apply) *:
Word of mouth
Internet advertising
Sales people
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
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

Please click below:


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