| Profile of Prospective Agent |
| First
Name*: |
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| Last Name*: |
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| Mailing Address*: |
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| City*: |
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| Province*: |
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| Postal Code*: |
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| Telephone Number*: |
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| Cell Phone Number: |
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| Email Address*: |
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| How did you Hear About the Agent Program?: |
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| First Language: |
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| Second Language: |
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| Current Occupation: |
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| Best time to contact: |
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| Internet Level: |
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| Describe any prior sales experience: |
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| Describe any prior Telecom experience: |
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| Which communities do you see yourself selling
Times Telecom Services to? Ie. church, organization: |
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| Briefly describe why you want to be a Times
Telecom agent: |
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| Comments: |
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