Primus Telecommuncations

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Agent Profile:	The * designates a required field.
Company Name*
Address*
City*		State*
Zip*		Phone Number *
Primary Contact Name*		Fax Number*
Primary Contact Title		How many sales people do you have?
Primary Contact Email*		Years in Business*
Partner Type*

	Please check your market segment (check all that apply):
	System Integrator (phone/LAN)
	Interconnect (PBX/key system)
	ISP (T-1/DSL)
	Selling (local/long distance)
	Other

	Products/services that you company represents (check all that apply)
	Local/CLEC services
	Long distance and calling card services
	Payphone services
	Toll-free services
	Conferencing services
	Voicemail services
	Cellular/wireless services
	Automated attendant and IVR services
	PBX/keyset equipment and installation
	ISP and VoIP services
	Other

	Which of the following markets can you serve? (check all the apply)
	Atlanta (Southeast)
	Chicago (North Central)
	Dallas (South Central)
	Houston (South)
	Los Angeles (Southwest)
	Washington DC (East Coast)
	NJ/NY (Northeast)

	Network certifications (check all that apply)
	Cisco
	HP
	Juniper
	Other

	How did you hear about Primus?
	Web search
	Web ad: TAA
	Web ad: TMC
	Marketing campaign
	News story/press release
	Co-worker/friend
	Trade magazine: Phone+
	Trade magazine: Internet Telephony
	Other

Or call us at 1-877-EVOIP-01 (877-386-4701)

Agents