Interested in becoming a Subagent
Company Information
Company Common Name:*
Company Phone:*
Ext.     At least 10 digits are required.
Company Address:*
Company Address 2:
Company City:*
Company State:*
Company Zip Code:*
Contact Person First Name:*
Contact Person Last Name:*
Contact Person Email:*
Contact Person Phone:*
Ext.     At least 10 digits are required.
Does the subagent have or perform the following
Retail Location(if yes, how many?): *  
How many?
Mall Kiosk: *  
Home based office: *  
Installation teams: *  
Event sales reps or team: *  
Direct Mail: *  
Print Media (news paper, magazine etc): *  
Door Hanging\ Flyers: *  
Inbound Call Center: *  
Outbound Call Center: *  
Door to Door sales team: *  
Online/Website [if yes, list all urls]: *  
Urls:  
Additional Questions
Have you sold CenturyLink services before? *  
How long have you been in business? *
What States and or Countries do you operate in? *  
What products do you currently sell?
DirecTV: *  
Dish Network: *  
Cellular: *  
Home Security: *  
Other:
How will you be selling CenturyLink services? *