Name
Contact Person
P.O.Box
City
Do you own a cafe Yes No
Email
Your main interests Pc2Phone
Broadband devices
Dial up device
Mobile dialer
Call back
How many minutes do you generate on a weekly basis (approx)
Full Address
Nearest Landmark
Phone
Alternative Phone
Mobile
Alternative Mobile
Referred By
Which providers you are currently selling from Add provider
Provider Name
Website
Bonus offered by percentage
Whole sale panel offered Yes No
Callshop Software available Yes No
NameWebsiteBOPWSOCSADelete
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