Application to Become An Internal Rep or Staff

Want to know more? Sign up to be an Affiliate for Tech Minded. Simply fill out the form below, and we'll get you more information.

Assoc ID
This is an internally used ID. It won't be known by the user, and needs to be filled in post-contract, before creating the user.
Name*
First Last
Company/Organization Name
Title
What is your title?
Username*
What would you like your login name to be?
Email*
Are you looking to become a Tech Minded Affiliate?
To speed the process along, by checking "Yes", you are requesting we reach out to you to answer any questions, as well as to create an Affiliate agreement (for which you have no obligations to until you sign). The information that you provide below will allow us to quickly generate an Affiliate agreement for you to digitally sign. This agreement gives us the ability for you to point potential clients to Tech Minded and be rewarded if they end up sign up for services.
- Yes
- No
Member Type
This is the type of Tech Minded member you are requesting to be.
Information We Need to Proceed
Address*
Street Address Address Line 2 City State ZIP Code
Phone: Work
Phone: Mobile
Phone: Main Office
Phone: Fax
Website
Additional Notes
Social Media for You/Your Organization
What is your organization's twitter account?
What is your organization's Facebook account?
What is your organization's LinkedIn page?
What is your organization's Instagram page?
CAPTCHA

Information We Need to Proceed