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Partner Application

    Thank you for your interest in the Results® Partner Program. Please complete the following Partner Application form and we will connect with you to discuss the program and its benefits.


    First Name*

    Last Name*

    Job Title

    Company Name*

    Address (Line 1)*

    Address (Line 2)

    City / Province*

    Zip Code*



    Phone Number*




    Number of years in Business*

    Number of All Staff within your organization*

    Number of Sales Staff within your organization*

    Number of Customer Service Staff within your organization*

    How many Clients do you currently serve?*

    What is your Client's average Gross Annual Income

    Your target Geographic Market

    Your target Industries

    Your current Certifications & Specializations

    Please indicate the services that you plan to offer (check all that apply):