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These leads are fantastic! Prospects are receptive and easy to talk to. There's no way I could ...

Nick A.

The leads we are getting are just AWESOME!! We are setting appointments everyday and enrolling ...

Cathy B.

First of all I want to thank you for your assistance on the phone today. You made it so easy to ...

Don

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Contact Information

First Name*

Last name*

Company*

Which best describes your business*

Position in Company or Distributor Level (if applicable):

Please Select Your Account Manager*

Address*

City*

State/Province*

ZIP/Postal Code*

Country*

Phone*

Cell*

Fax*

Email*

Website*

How many years have you been in the industry?*

How many members are in your company or organization?*

Please provide a Peak Impact specific sales forecast (per quarter and per year)*

Business & Marketing Profile cont'd

Describe your current relationship to Peak Impact.*

Indicate which of the following methods you will use to market and promote Peak Impact products*

What would you like your Lead Store to be named?*

Would you like us to provide you with one of our generic Lead Stores? Or, for an additional one-time charge of $300, we will provide you with a custom designed Lead Store.*

Would you like us to provide Customer Service to your customers? (Please note, by choosing “yes” your customers will be aware that it is Peak Impact providing support and generating the leads they are purchasing from your lead store.*

Would you like specials posted on your reseller site? (There is no cost for participation in our specials.)*

Would you like us to notify you customers of specials via our email newsletter? Would you like us to communicate with your clients by email?*

Reseller Commission

How would you like to receive your reseller commission(s)?*

PayPal (Free) Provide your Paypal email below

Check (Please provide in the space below the payee for the check along with the mailing address if different from above)

Wire Transfer ($30): Bank account information will be requested at time of account activation.

Check or Paypal payment information*

I have read and agree to the Agreement


Association of Internet Marketing and Sales Canada	Direct Sellers Association of Canada	The Online Lead Generation Association	Direct Marketing Association	Canadian Marketing Association