Strategic Partners Application Form

Date

Business Name

Principal First Name

Principal Last Name

Business Address, City, State & Zipcode

Your Email Address

Mobile Telephone Number

Office Telephone Number

Fax Number

Website URL

Year Founded

Legal Structure, e.g. Incorporated, LLC, Sole Proprietor, etc

Date of Incorporation

Number of Years in Business

Years at present location

TOTAL FT STAFF

TOTAL PT STAFF

Provide a short description of your company

Summarize the nature of your business and why you want to become a Strategic Partner.

As a Strategic Partner, what savings, discounts or benefit incentives would your company offer to CEG members?

______________________________

STRATEGIC PARTNER COMMITMENTS:

1. Pay a yearly membership fee.
NOTE: Fees are not due until board approval of your acceptance into the program.

Choose only one:
"$100 (Small size company with annual sales less than $500K)"
"$200 (Medium size company with annual sales from $500K to $1MIL)"
"$300 (Large size company with annual sales over $1MIL)"
"$1,000 (Major Corporation)"

2. Document CEG Member Benefits
Track and report CEG member sales and incentives

3. Support CEG events
Attend and participate in CEG Meetings and Events

______________________________

STRATEGIC PARTNER DECLARATION AND AUTHORIZATION:

I hearby certify that my answers to the questions appearing in this Strategic Partnership Application: General Information form are true and complete.

*SUBMIT your signature electronically by selecting the "I Accept" button and type your first and last name and date in spaces provided below. This is your agreement that your electronic signature is the legal equivalent of your manual signature on this declaration and authorization page, consent to be legally bound by this declaration and authorization page.

I ACCEPT

My electronic signature and today's date

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