Affiliate Application Form

Application Form
Please complete all details below, then click Submit. Your application will be assessed and ACS will contact you with further information. Upon approval of your application you will have access to support and training to get started. Acceptance of your application is subject to your general acceptance of the sentiment of the typical ACS Affiliate Agreement. The agreement is a starting point for negotiation. ACS is able to be flexible in some respects to fit your requirements, but the basic sentiment of the agreement would remain the same. Please review this agreement before applying. I have read the Affiliate Agreement.
Personal Information
First Name
Surname
Title/Function
Department
E-mail
Direct Phone
Company Information
Company Name
Main Phone
Main Fax
Address
City
State
Postcode
Country
Website
Number of staff	Sales: Academic:
Annual revenue
Markets Sold to	Fortune 500 Government SMB Education Consumers Other
Years in business
Top 3 customers
Professional Affiliations
Current Quality Accreditations held
Which courses are you interested in promoting?	Horticulture IT Writing Agriculture Fitness/Leisure Hospitality Business Psychology Environment Other
Qualifications you wish to promote/license	Individual Modules Diplomas Certificates Degrees
Current courses offered	None Certificates/Diplomas Individual Modules Degrees Other
Further Information
Why do you wish to become an affiliate?
Why should ACS select you as an ideal affiliate?
Any additional information or comments
Please attach CVs of senior staff members (Please compress multiple CVs into a .zip or .rar file. Max size 2MB)
Would you like to receive the ACS newsletter?	Yes No

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