Licensee Registration Form - Strategic Partner/White label Partner

This registration page is for companies that wish to become a strategic white label partner for the JAZreturns conversion tracker service.

You may only complete this form if you have previously contacted e-JAZ regarding the possibility of your company offering a White Label or re-branded version of the JAZreturns conversion tracker service. If you have not previously contacted e-JAZ in that regard, please contact us first.

Fields marked with * must be completed.

Your Company Details

Company Name *
Company Street Address *
Street Address*
City/Suburb*
State/Province*
Zip/Postcode*
Country*
Company Postal Address
Postal Address*
City/Suburb*
State/Province*
Zip/Postcode*
Country*
Company Phone Number*
Company Fax Number*
Company Website URL*
Your primary contact person*

Name
E-mail
Position Title

Accounts e-mail address

(e-JAZ will send information about account changes to this e-mail address)
Billing e-mail address
(e-JAZ will send the monthly bill to this e-mail address)
Authorised Company Officer*

Name
Position Title
(The person in your company who has authorised your company to enter into this agreement eg. CEO,COO, Director)

   

Support

Support phone number
(we recommend international format)
Support e-mail address
(Your clients will e-mail this address with support problems)
Support URL
(a contact us page, or a page with support information on it)
URL for the manual

(If you would like to host the online user manual please type the url in the above field. For example http://www.mycompany.com/manual/ and clients will go to that url to see your manual. Otherwise the manual will be hosted at the url shown above.)
   

Service and Reports

*Clients are e-mailed daily, weekly and monthly reports. They will appear to be sent from your company.
What would you like to call the service


(eg. e-JAZ call it JAZreturns)

Name that the email will be sent from
(For example "JAZreturns Reports")
Email address that the email will be sent from.


(For example reports@mycompany.com - must be a valid email address)

   
Terms

I agree to the terms listed above*