Referral Partner

REFERRAL PARTNERS PROGRAM

Deltacom Homepage

> Home

> Step 1 Sign Up

> Step 2 Pick a Plan

> Step 3 Create Login

Step 1 > Sign Up

Enter your personal information

First Name

Last Name

Address 1

Address 2

City, State, Zip

Phone Number

(Format 999-999-9999)

Fax Number

Business Name

Federal Tax ID#

I acknowledge that in order to participate in the ITC^DeltaCom Referral Partner Program, I must be operating as a business and not as an individual. ITC^DeltaCom reserves the right to review my business status at any time during the term of my contract.
Agree Disagree

E-mail Address

Enter a valid E-mail address

Retype E-mail Address

Enter the same valid E-mail address

Are you an ITC^DeltaCom Customer?

Yes No

Who is your ITC^DeltaCom Representative?

Representative Name
Representative Code

Tax Information

You are now beginning the W-9 form

Full Legal

As it will be reported on a federal tax return

Street Address

City, State, Zip

Each company must register by this unique company ID for tax purposes. Please verify your
information before you proceed*

* Please exclude dashes from the EIN/SSN

Business Type	Tax Identification
Corporation	EIN	Reportable Name
Partnership* *The reportable Tax ID# is the partnership's Employer Identification # (EIN)	EIN	Reportable Name
Sole Proprietorship A Sole proprietorship may have a "doing business as " name, but the reportable name is the name of the business owner. The reportable Tax ID# is either the owner's Social Security #(SSN) or their Employer Identification#(EIN)	SSN	Reportable Name