CenturyLink Channel Alliance

Application

If you would like to find out more about the CenturyLink Channel Alliance, please complete the application below. The information will be kept confidential and does not commit your company to joining the program. A CenturyLink representative will review your application and contact you within a week.

If your company is not yet ready to commit to the minimum revenue requirements, you can provide your customers with CenturyLink's world-class products by becoming a sub-agent to a CenturyLink Premier Elite Member. See the Sub-Agent Resources page for information.

Members of the CenturyLink Channel Alliance must have at least one physical office within the United States.

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Company Information
Organization Name *

URL *	(http://www.website.com / www.website.com / website.com)
Business Address
Address 1 *

Address 2

Address 3

Address 4

City *

State *

Country *

Zip/Postal Code *

Phone *

Fax
Approximate Gross Annual Sales

Number of Employees

Primary Contact Information
Contact Name *

Salutation *

Title *

Email *

Partner Application
How did you hear about the CenturyLink Channel Alliance? *

What other Partner programs are you currently participating in?

Does your company have Sub-Agents?

If yes, how many Sub-Agents?

Describe products and services you sell and/or provide? *