Application Form

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

* Required Fields

 

*Company:
*First Name:
*Last Name:
*Address:
*City:
*State/Province:	Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Colombia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin West Virginia Wyoming Other...
*Zip:
*Phone:
Fax:
Website:
*Email:
*Products You Market or Sell: (Select all that apply)	MIP NPS Intro and Pro MIP Advantage NonProfit Series All MIP products and services Great Plains Software Peachtree Software Software Training Software Product Support Consulting ABRA Custom Software Web Design Services Other Fundraising Software Other - describe in Comments below
*Number of Clients:
*Number of Employees :
*Number of Sales Reps:
*Years in Business:	--None-- Less than 1 year 1-2 years 3-5 years 5-7 years 7-9 years 9+ years
*Number of Offices:
*Client Segment Focus:	--None-- NPO NPO and Gov't NPO and Corporate NPO and Other
Geographic Focus: (Select all that apply)	Northeast US Southeast US Northwest US Southwest US Canada - any province International
Date Introduced to Telosa
*Reviewed/Requested Telosa Demo:	--None-- Yes No
*Approximate Annual Sales:	--None-- Less than $50K $50K-$100K $100K-$150K $150K-$200K $200K+
Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Channel Application