Company - Partners - Referral Form

This form is for use by Triad Exchange Referral Partners who have been accepted into the program and assigned a sales ID. If you do not have a sales ID, please complete the program application first.

Current Referral Partners: please supply the following information regarding your sales lead. A Triad Exchange representative will send you a referral acknowledgment and confirm whether it is an eligible lead. E-mail partners@triadexchange.com with questions.

* Indicates Mandatory Field

Referral Partner Information:

 Sales ID:*
 First Name:*
 Last Name:*
 Company Name:*
 Phone:*
 Email:*
 City:*   State:*   Zip:*   

Prospective Customer Information:
 Company:*
 Contact Name:*
 Phone:*
 Fax:
 E-Mail:
 Address:*
 City:*   State:*   Zip:*   
 Type of Service Interested In:*
MMS Extranets Collateral
Strategy Other
 May Triad Exchange indicate that your company referred the customer to us?*
Yes No
 Comments or Questions?
 Please write any special comments or questions in the text box below and hit  submit:


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