Customer Input Form

CRM Alliance Membership Application
Company Name:*


First/Last Name:*


Mailing Address1:*


Mailing Address2:*


City:*


State:*


Zip:*


Office Phone:*


Mobile Phone


Email address:*


Web Site*


Primary Geographic Territory:*


# of years as an ACT!, SalesLogix, Sage CRM, ACCPAC/Sage ERP and/or MAS Certified Consultant? (please enter each certification and number of years seperated by a comma)*


# of ACT!, SalesLogix, Sage CRM, ACCPAC/Sage ERP and/or MAS Certified Consultants on staff? (please enter each certification and number of techs seperated by a comma)*


Are you affiliated with any other group of CRM consultants? If yes, please explain below:*


Please list at least 2 Certified Consultants in your channel or customers as references? (include name, phone and nature of relationship)*


Why do you want to join The CRM Alliance? *


Who are your competitors in your channel? *


* Indicates field is required.