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CosmoLex Partner Information Form
Please fill out the questions below so we may list you on our Consultant Directory and construct your dedicated landing page.

All fields must be completed before your dedicated landing page may be created.

Name of Company
Your answer
Name of Consultant(s)
Your answer
State where company is headquartered
Your answer
State(s) where company does most of its business
Please name up to 5 states at this time.
Your answer
Company phone number
(###) ###-####
Your answer
Company website
Please include http://
Your answer
Company email
Your answer
Description of company/consultant
This paragraph will be used on your landing page.
Your answer
List of 4-8 services provided by your company
Maximum 8 services. This list will be used on your landing page and partner flyer.
Your answer
Please select which other systems your company currently consults clients on on a regular basis.
Please select all that apply.
Additional notes
social media accounts, additional consultants, etc. This will be included on your landing page.
Your answer
Submit your images
Please send an image file of your company logo and (optional) headshot to to be used on your directory listing and dedicated landing page.
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