Expression of Interest Form

Company information:

Personal information:

What partnership option are you considering?

To which locations do/will you provide direct services?

State based or National - specify % per location

Staffing information:

Describe your main competitive advantages:

Who are your main competitors?

Who are your strategic partners?

Does your business have a vertical market focus?

In submitting this application form to Partner Wholesale you have acknowledged that the information provided is accurate and relevant. If you provide
us with incomplete or inaccurate information, you may not be able to participate in the Partner Wholesale strategic partner model.