Partner Application Form

Thank you for your interest in the Telosa Partner Program. Please complete the following information so that we can learn more about you and your business. This information will be reviewed by Telosa as consideration for participation in the Partner Program. Please contact us with any questions or comments at 800-676-5831 x115. Thank you.

*= Required Information

 

*Organization:
*First Name:
*Last Name:
 
*Email:
 
*Phone:
 
Fax:
Website:
*Address:
*City:
 
*State/Province:
 
*Zip:
 
*Products You Market or Sell:
(Select all that apply)
*Number of Clients:
*Number of Employees :
*Number of Sales Reps:
*Years in Business:
*Number of Offices:
Client Segment Focus:
Geographic Focus:
(Select all that apply)
Date Introduced to Telosa
*Reviewed/Requested Telosa Demo:
*Approximate Annual Sales:
Comments: