Business Information

Organization URL:  

What is your Target Market?   --Choose One-- Consumer Business Both

What program will benefit your organization?   --Choose One-- Partner Reseller Both

What services does your organization primarily sell?

What marketing methods do you currently use to promote your services?

What services are you interested in selling through Nationwide? (choose all that apply)

T1 Services	DSL Services	Colocation	Wireless Broadband
Web Hosting	VoIP Phone Services	Web Design	Dialup
Other: (please describe)

How many Services do you plan to sell through Nationwide each month? (enter amounts)

T1 Services 1-10   10-50   50-100+	DSL Services   1-10   10-50   50-100+
Colocation (1/4 rack increments) 1-10   10-50   50-100+	Wireless Broadband 1-10   10-50   50-100+
VoIP (phone stations) 1-10   10-50   50-100+	Web Hosting 1-10   10-50   50-100+
Web Design 1-10   10-50   50-100+	Dialup 1-10   10-50   50-100+
Other Product(s) 1-10   10-50   50-100+

Additional Comments