ConectUS Wireless

APPLICATION FOR BUSINESS AGENT & DIGITAL aGENT PROGRAMS

INSTRUCTIONS: To avoid processing delays and rejection of application, please complete all requested information on this Application form. Do not leave any blank spaces. If requested information does not apply, please indicate with “N/A” or “NONE”.

NOTE: Through this application for potential Subagent of Agent to sell Verizon Wireless’ cellular mobile radio service, Verizon Wireless’ only obligation is to advise Agent with the final result of Verizon Wireless’ review of the application (approved or not approved). Verizon Wireless requires that its agents, and agent’s subagents, meet the highest standards of integrity and quality.

Partnered for Verizon Wireless
If you do not have a D&B number, you can obtain one here:
https://www.dnb.com/duns-number/get-a-duns.html
Same as address above?
Please supply a small paragraph on your business model. Include your Company value-adds and what other services you provide.

Sub Agent Company Stakeholder(s)

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