Interested in becoming a Subagent

Company Information Company Common Name:* Company Common Name is already exists Company Phone:* Ext.     At least 10 digits are required. Company Address:* Company Address 2: Company City:* Company State:* Please Select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY 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?): * YES NO   How many? Mall Kiosk: * YES NO   Home based office: * YES NO   Installation teams: * YES NO   Event sales reps or team: * YES NO   Direct Mail: * YES NO   Print Media (news paper, magazine etc): * YES NO   Door Hanging\ Flyers: * YES NO   Inbound Call Center: * YES NO   Outbound Call Center: * YES NO   Door to Door sales team: * YES NO   Online/Website [if yes, list all urls]: * YES NO   Urls:   Additional Questions Have you sold CenturyLink services before? * YES NO   How long have you been in business? * Less than 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years 26 years 27 years 28 years 29 years 30 years 31 years 32 years 33 years 34 years 35 years 36 years 37 years 38 years 39 years 40 years 41 years 42 years 43 years 44 years 45 years 46 years 47 years 48 years 49 years 50 years More than 50 years What States and or Countries do you operate in? *   What products do you currently sell? DirecTV: * YES NO   Dish Network: * YES NO   Cellular: * YES NO   Home Security: * YES NO   Other: How will you be selling CenturyLink services? * DEALER PREMISE DEALER OFFSITE/EVENT CUSTOMER PREMISE CALL CENTER CUSTOMER CALL IN