ECG Agent - Agent Opportunities

1. How did you hear about ECG?

Other:

2. How long have you been selling telecom products/services?

years months

3. Briefly describe your background in telecom:

4. What best describes you?

5. What products are you currently selling?

Long Distance - business
Long Distance - consumer
Local (UNE-P)
Data
Internet
Conference Calling
Co-location
Data Storage
VoIP
Web Hosting
Auditing Services
Other:

6. What ECG products are you interested in adding to your portfolio?

Long Distance - business
Long Distance - consumer
Data
Dedicated Internet Access
Conference Calling
Web Hosting

7. What percentage of your existing base are business customers?

%

8. What percentage of your new sales are business customers?

%

9. Which marketing channels do you currently utilize?

Web Site
Direct Sales
Mass Mailing
Agents
Affinity Groups
Other:

10. How much revenue is your telecom customer base currently producing on a monthly basis?

11. Comments:

GENERAL INFORMATION

Company Name:

Agent Name:

E-mail address:

Address:

Address Continued:

City:

State:

Zip Code:

Phone Number:

Mobile Number:

Fax Number:

Primary Contact Name:

Job Title:

Federal ID#:

Type the Security Code shown below:

(4 Letters followed by 4 Digits)

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