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Referral Partner Application

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Please complete this form to apply as a LiveHelpNow REFERRAL partner. Call (267) 888.5760 if you have any questions. Thanks.

Referral Partner Application

Step 1 of 2

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Company*
Name*
First Last
Title*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Website*

Business Type*
- Individual - non-business
- Proprietor
- Partnership
- Corporation
Classification*
How would you classify yourself? (check all that apply)
- Individual - non business
- Influencer
- Blogger / Forum
- Consultant
- Retailer
- VAR
- MSP
- System Integrator
- Distributor
- OEM
- Developer
- Chain or Franchise
- Training
- Mail Order
- E-Commerce
Target Audience
If a blogger, influencer, consultant, reseller, etc. - do you target a particular company type?
Projected Revenue
Anticipated revenues this year? If applicable.
Geography*
What geographical area(s) do you serve (check all that apply)
- Does not apply
- Local (50 mile)
- State Wide
- Regional (multiple states)
- National
- International
Relationships & Certifications
Please list primary vendors you have a formal relationship with (reseller agreements). Include key certifications.
Similar or Complimentary Products
List other products you work with that are similar or complimentary to our products.
Value Added Services
Provide a description of your primary "Value Added" services (integration, training, custom development, consulting, etc.) - if applicable
Date
Select today's date
MM slash DD slash YYYY
Referral Agreement (please read)
Click HERE to view the Partner Agreement (opens in its own window). Please email or call the Partner Manager if you have any questions. By submitting this form, I agree to the terms of the referral partner agreement.
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Name
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Telephone

Text or Call (267) 888.5760

Email

partners@livehelpnow.com

Address

515 S West End Blvd
Suite #202
Quakertown, PA 18951

Business Hours

Open 9 am – 5 pm (EST)
Monday – Friday

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