Thank you for your interest in becoming an agent for US Monitor. We are looking for agents in all states throughout the USA, as well as Canada, Mexico and other countries. To meet our current requirements, you must be computer literate and have everyday access to your computer.
In order for you to qualify, you MUST provide the following information. After you complete the information, your application will be processed.
| Salutation: | |
| Your Name: | |
| Address 1: | (Street address only. No PO Box) |
| Address 2: | (Optional) |
| Apt. No.: | (Optional) |
| City: | |
| State/Province: | |
| Zip/Postal Code: | |
| Country: | |
| Phone: | |
| Fax: | (Optional) |
| Email: | |
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| How long have you been at this residence? |
Do you plan on moving within the next 3 years? Yes No
|
| If Yes, when? |
| Do you have someone who can process the mail in your absence? Yes No |
| Do you act as a mail receiving/forwarding agent for another company? Yes No |
| If YES, which company do you work for? |
| Do you have access to a computer? At home At the office Both |
| Would you process US Monitor mail at: Home Office Both |
| When would you typically do the work for US Monitor? |
| Morning |
| Afternoon |
| Evening |
| No regular time |
| If you use a computer, please try to answer as much as possible of the following: |
| 1. Make of computer: |
| 2. Processor type (Pentium III, etc): |
| 3. Operating System (Windows 98, NT, 2000, XP): |
| 4. RAM (128, 256): |
| 5. Email program (Outlook, AOL, Yahoo): |
| 6. Browser(Internet Explorer, Netscape, AOL): |
| 7. Browser Version(5,6,7): |
| How do you access the internet? |
| Office network |
| Office dial-up |
| Home dial-up |
| Home cable modem |
| Home DSL |
| Other |
| How often do you check email? |
| Several times daily |
| Once daily |
| Every 2-3 days |
| Weekly |
| Less Regularly |
| Which internet service provider do you use? |
| AOL |
| Yahoo |
| MSN |
| Earthlink |
| Other |
| Would you be interested in making calls or web requests on behalf of US Monitor's clients? |
| Yes |
| No |
| If Yes, are you available to:(check all that apply) |
| Phone companies to request brochures/products in normal business hours 9-5 |
| Fill in web applications for brochures/products in normal business hours 9-5 |
| Are you interested in participating in future projects/surveys? Yes No |
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| Do you have any friends/relatives (located anywhere in the WORLD) who may be interested in participating in this opportunity? If YES, please have them visit this site and fill out this form. |
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Last modified: May 30, 2004 |
