Company Details

Company:

CEO:

Date of Incorporation:

City:

State/Province:

Address:

Industry:
–None–AgricultureApparelBankingBiotechnologyChemicalsCommunicationsConstructionConsultingEducationElectronicsEnergyEngineeringEntertainmentEnvironmentalFinanceFood & BeverageGovernmentHealthcareHospitalityInsuranceMachineryManufacturingMediaNot For ProfitOtherRecreationRetailShippingTechnologyTelecommunicationsTransportationUtilities

Annual Revenue:

Employees:

Work Phone:

Primary Sales Contact

First Name:

Last Name:

Email:

Title:

Phone:

Mobile:

Fax:

Why are you interested in becoming an Avenue100 partner?:

Proposed Promotional Type:
EmailLink OutHost/PostBannerCall CenterOther

Other Promotional Type:

Previous CourseAdvisor affiliate?:

Please provide details:

Technical Contact Information

First Name:

Last Name:

Title:

Email:

Phone:

Fax:

Traffic Source information

Website

Date Site Launched:

Unique Visitors/month:

Est. Monthly Lead Volume:

Projected Lead to Enrollment %:

Traffic type ratios

Email %:

SEM %:

SEO %:

Banner %:

Other %:

Please provide two references

1st Reference Company Name:

1st Reference Website:

1st Reference Contact Name:

1st Reference Email:

2nd Reference Company Name:

2nd Reference Website:

2nd Reference Contact Name:

2nd Reference Email: