Urban Wireless USA

Telecom Retailer Program Application Form

Welcome ! Quick fill the application form. This form is the first step in the process to get enrolled in the program.

Each field is mandatory.

If you have any questions, please contact us at (888) 215-6955

Urbanwireless: Enrollment Team

Select The Program of Interest *

Business Entity Name [DBA] *

Nature Of Business *

Business Location Type *

Average Daily Traffic - [ Unique Customer Attended ] *

Business Is " Not Dealing in "

Alcohol

Tobacco & Vaping

Phonography

Arms & Ammunition

Thrifty Shop

Website - If Any *

Check - Whats Applicable to Your Business *

Do Local Social Media Marketing

Do Local Events

Do Flyers / Traditional Marketing

Have a dedicated Sales Employees

Image - Front of Business Location *

Image - Inside of Business Location *

Call Appointment - Date & Time *