Apply For The Authorized Dealer Program
All Fields Are Required
Full Legal Name
First Name
Middle Name
Last Name
Tax Payor ID Number
Tax Payor ID or Social Security Number
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PayPal E-mail (so you can be paid)
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
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1975
1974
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1971
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1939
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Preferred Username (this will become part of your URL)
Keep me informed
Yes
No
Upload Photo (this must be a recent photo as your badge will be made using this photo to identify you as an authorized dealer. It will also go on your About Us page of your Web Agency website if you are accepted into the program and you purchase the Authorized Dealer Sales Materials. No purchase is necessary to qualify for our Authorized Dealer Program.
Upload a File
Cancel
of
Pick A Date For Your Phone Interview
-
Month
-
Day
Year
Date
Select A Time For Us To Expect Your Call
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
What is your desired monthly income goal?
$500
$1500
$2500
$5000
$8000
$10,000 or more
$25,000 or more
$50,000 or more
Check all that apply Please check any box that you are experienced in.
Web Development
Web Design
Graphical User Interface
Graphic Arts
Video Production & Editing
Software Development
Mobile App Developer
B2B Sales
Team Building
Social Media Management
Lead Generation
Advertising
Affiliate Management
Public Speaking & PR
Article Writing
E-Commerce
Wordpress
HTML5 & CSS3
JavaScripting
PHP Programming
Email Marketing Management
Accounting & HR
Receptionist
Business Management
Adwords & PPC Marketing
YouTube Advertising
Facebook Advertising
Conducting Webinars
Please type the full name of your referring agent here in this box, you can find their name on the About Us page on their Authorized Dealer Website. If none how did you hear about us?
Your Team Leaders First & Last Name
Are you interested in an employee position and if so what qualifications do you have? If you are only interested in the business opportunity please say so.
Please add your comments in the text box above.
What is your current occupation now?
What is your biggest reason why you want to start your own business?
How many hours per week are you willing to devote to growing your business and making sales?
10 hours per week
20 hours per week
30 hours per week
40 hours per week
70 hours per week
How much money do you have on hand to invest in your business?
None, this is great!
$100
$200 - $500
$1000 - $1999
$2000 - $5000
$10,000 - $20,000
$25,000 - $50,000
$50,000 - $100,000
Check All 3 Boxes Below To Agree
*
I have read the earnings disclaimer at: www.IMS.zone/prelaunchcountdown/disclaimer.html
I am responsible for my own taxes
I am over 21 years of age
e-Signature Required
Submit
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