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Questions marked with a * are required Exit Survey
 
 
* How Long Have you been in business?
 
0-1 year
 
2-4 years
 
5-8 years
 
9+ years
 
 
 
* Do you plan on selling over the phone or direct marketing?
 
Phone Sales
 
Door to Door
 
Both Door to door and Phone Sales
 
 
 
* What are you currently selling?
   
 
 
 
* How many sales do you currently make per month with your current product?
   
 
 
 
* What is your Current marketing strategy? (Internet, Live Transfers, TV/Radio, Print)
   
 
 
 
* Please indicate if this will be a primary product of sale, extended or cross sale?
 
Primary Sale
 
Extended Sale
 
Cross Sale
 
 
 
* How many reps would you plan on dedicating to this campaign if you were accepted to the affiliate program?
 
0-5
 
6-10
 
11-20
 
20-50
 
50+
 
 
 
* Please select your sales goals (Number of new customers per day) for the 90 day time frame listed below:
 
5-10 Sales per day (90 Days)
 
11-20 Sales per day (90 Days)
 
20-40 Sales per day (90 Days
 
40+ Sales per day (90 Days)

 
 
 
* We are only looking for 1-2 more affiliates.... Why should we choose you?
   
 
 
Please fill out your contact information below. Once we review all of the Appliacants we will contact you if we feel you would be a good candidate.
First Name : 
Last Name : 
Phone : 
Email Address :