Qwest® Direct Awards Application 
 
If you would like to find out more about the Qwest Direct Awards Program, please complete the application below. The information will be kept confidential and does not commit your organization to joining the program. A Qwest representative will review your application and contact you within a 48 business hours.


* Indicates required fields

I am a Qwest Employee adopted school: Yes     No
If you were referred by a Qwest employee enter their reference code:

Organization Information
     
*Organization Name:
  
*Head of Organization:
  
*Federal Tax ID:
  
URL:
  
*Organization Description:
 

Please limit your description to 100 characters
 
Number of Students:
  
(required for schools/PTAs)
Number of Member Businesses:
  
For Chambers of Commerce and other business professional organizations
Number of Individual Members:
  
Years in Operation:
  
 
Organization Address:
  
 
*Address Line 1:
  
Address Line 2:
  
Address Line 3:
  
Address Line 4:
  
*City:
  
State/Province:
  
*Zip/Postal Code:
  
*Phone:
  
FAX:
  
 
*First Name:
  
*Last Name:
  
*Salutation:
 
*Job Title:
  
*Email:
  
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