Applicant First Name
*
Applicant Last Name
*
Phone Number
*
(000-000-0000)
Ext.
Email
*
Business Legal Name
*
Doing Business As
Mailing Address
*
City
*
State
*
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WI
WV
WY
Zip
*
Have you been involved in any litigation in the last 5 years?
*
Yes
No
Please explain
How did you learn about the T-Mobile limited Retailer Program?
- - - - - - - - - - - - - - -
Postcard/Mailer
Newspaper/Magazine
Trade Show
Internet Search
T-Mobile.com Website
T-Mobile Business Development Team
Referred by T-Mobile Employee/Retailer
Please enter the employee's name:
Please enter the employee's email:
Retail Opportunities:
How would you like to sell T-Mobile?
Open T-Mobile Exclusive store(s)
Open multi-carrier store(s)
Add to my current products
Non-Retail Opportunities:
What opportunity(s) are you interested in?
Business Sales: Creating and selling customized business products
Machine to Machine: Selling data monitoring and asset tracking services using the T-Mobile network
To complete registration via telephone call -
1.877.286.7922