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AFFILIATE INFORMATION FORM

Thank you for your interest in joining the Threshold Network™. We normally respond to inquiries within 72 hours. Please fill out and submit the form below, or send an email to John Patberg , or simply call (732) 565-9810.

Thank you.

CONTACT INFORMATION

your Name:

your Phone:

your Email:

Company Name (if applicable):

your position with the Company (if applicable):

Address:

Address 2:

City:

State / Province:

Other International:

Country:

ZIP/Postal Code:

Company URL:

HOW WOULD YOU LIKE US TO CONTACT YOU?:

HOW DID YOU HEAR
ABOUT US?:

TELL US ABOUT YOURSELF / YOUR COMPANY

Please briefly describe your backgrounD /your company:

how many years of experience do you have? (AND / OR) WHEN WAS YOUR COMPANY FOUNDED?

please list any advanced degrees held and schools attended:

describe the products/services you or your company offers:

are you currently providing business development or capital consulting services? if so, to what type of companies?

what industries do you/your firm specialize in?

how much revenue do you/your company generate annually from these activities?


HOW DO YOU THINK YOU / YOUR FIRM COULD WORK WITH THRESHOLD PARTNERS?

please tell us Anything else you feel is important for us to know:




 

 

 

 
 
   
 

 

 

 

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