JPAR - Brokerage B2B Agent Referral Form

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Email *

Agent Name *

Date of submission *

YYYY

Recommended Partner Name *

refers to company name you are recommending to JPAR to be a preferred partner

Partner Website *

can enter Facebook page if there is no website

Category (What business do they do) *

Partner Contact's Name *

refers to primary contact person in the company you are recommending to JPAR to be a preferred partner

Partner Contact's Phone number *

Partner Contact's Email Address *

How long have you known the vendor? *

Have you personally used them? *

Other comments?

Send me a copy of my responses.

Submit

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