If you are interested in some type of business partnership, please fill out the questions below and someone from our staff will get back to you.

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* 1. Address

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* 2. What is your company name and website if you have one?

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* 3. Where was your company incorporated and when?

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* 4. Please describe your current business and do you handle billing relationship with your customers?

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* 5. How many customers do you have now? Where are they located. How many do you have access to?

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* 6. Are you focused on a specific geography? Which one?

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* 7. Are you focused on local population within a geography or people who have relocated from other countries? Which ones?

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* 8. How do you propose to work with us? Please describe in detail.

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* 9. Other comments

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