| Enter your personal information |
| First Name |
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| Last Name |
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| Address 1 |
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| Address 2 |
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| City, State,
Zip |
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| Phone Number |
(Format 999-999-9999)
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| Fax Number |
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Referral Partner Type |
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| If you are a business, please fill out the following |
| Business Name |
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Describe your business |
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How long have you been in business? |
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I acknowledge that in order to participate
in the EarthLink Business Referral Partner Program, I cannot be a relative of an employee, a current agent/channel partner/reseller, or a previous employee unless I have been separated for longer than three months
Agree
Disagree |
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Are you an EarthLink Business Customer? |
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Yes
No |
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How did you learn of the program? |
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Describe where your referrals would originate. |
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How many referrals would you expect to provide
in an average month? |
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Are EarthLink Business services in some way related to
your business? |
Yes
No |
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What is your familiarity with
telecommunications voice and data services?
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Do you have a lead you would like to submit
once approved? |
Yes
No |
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Formal or informal reciprocity, financial or
through other means of value, for exchange of
lead information is prohibited.
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In what city will most of your leads reside? |
|
| Email Address |
Enter a valid email address |
| Retype Email
Address |
Enter the same valid email
address |
| Are you
working with an EarthLink Business representative? |
Yes
No |
|
Representative Name |
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| |
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| Please take a moment to download and
complete this
W-9 Form, using this link. This form will need to
be faxed to 256-264-0581 before your
application can be considered.
|
Commission Payment Type |
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Please select your desired commission payment type. Referral Partners may change payment types once per year.
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| |
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| One-Time Payment |
An upfront, one-time payment equal to 100% of the eligible monthly recurring revenue of the referral sale.
Terms and Conditions
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| Residual Payment |
A payment equal to 6% of the eligible billed monthly recurring revenue paid over the life of the customer's contract.
Terms and Conditions
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Tax Information |
Each applicant
must register with this unique company or
personal ID for tax purposes. Please verify your
information before you proceed*
* Please exclude dashes from the EIN or
SSN
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