Affiliate Enrollment  

Affiliate Enrollment


Independent Sales Organization Application

Your Name:
Company:
Address:
City: State: Zip:
Telephone:
Fax:
Email:

Additional Required Information
How did you hear about OfficeTellerTM:
Type of Affiliation Desired:
Your "Referring Source E-Mail": Example: ReferralSource@E-mail.com
Your Website Address ("URL"):
Example: http://www.yourcompany.com
Type of Business Entity:
Federal Tax ID Number (or SSN):
Years in Business:
Describe Type of Goods / Services Sold:
Monthly Sales Volume:
Average Sale Amount:
Your Bank Information
Bank Name:
Address:
City: State: Zip:
Contact Name:
Bank Telephone Number:
Bank Routing Code (9 digits): Bank Account Number:
Comments:
Remember, after you submit this Online Independent Sales Organization Application we will contact you and transmit the Business Referral Agreement.

Copyright © 2003 OfficeTeller.com | Privacy Policy | Affiliates


For more information:
(866) 927-7180


© Copyright 2004 OfficeTeller, Inc.. All Rights Reserved.