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Verizon Partner Program (VPP) Application

APPLICATION FOR BUSINESS AGENT & DIGITAL AGENT PROGRAMS

INSTRUCTIONS: To avoid processing delays and rejection of the 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 a potential Sub-Agent of ConectUS to sell Verizon Wireless’ cellular mobile radio service, Verizon Wireless’ only obligation is to advise ConectUS of the final result of Verizon Wireless’ review of the application (approved or not approved). Verizon Wireless requires that its agents and sub-agents meet the highest standards of integrity and quality.

New Sub Agent Company Name

What type of Telecom Partner are you?

Are you a partner with another Verizon Principal Agent?

Yes

Partnered for Verizon Wireless

Sub-Agent Company Phone Number

Year Company Established

Number of Company Employees

Sub-Agent Company Address

Dun & Bradstreet D‑U‑N‑S Number

If you do not have a D&B number, you can obtain one here:
https://www.dnb.com/duns-number/get-a-duns.html

Main Corporate Contact Name

Main Corporate Contact Title

Main Corporate Contact Email

Main Corporate Contact Phone

Main Corporate Contact Address Same?

Yes

Different

Main Corporate Contact Address

Main Corporate Contact Month and Day of Birth (MM/DD ONLY)

Short Description of your Business Model

Sub-Agent Company Stakeholder(s)

How many Principals/Owners owning 20% of Sub-Agent’s company?

Do you want others to have access to commission reports and other sensitive documents?

Yes