Partner Sign Up:
Please fill out this reseller application to gain access to the reseller's section of our website. Please note
that the password requires at least 6 characters.
Account Information
*
Password:
*
Confirm password:
Company Details
*
Name of the Company:
Website:
*
Established Year:
*
Federal Tax ID/GST, PST, or HST:
Sales per Year (US$)
# of Employees:
*
Telephone number:
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-
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Fax number:
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Address
*
Street Address:
Address Line 2:
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City:
*
State / Province:
*
Postal / Zip Code:
*
Country:
Shipping Address
*
Street Address:
Address Line 2:
*
City:
*
State / Province:
*
Postal / Zip Code:
*
Country:
Contact Information - Owner/President
Title
Name
E-mail
Telephone number:
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-
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Mobile number:
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Contact Information - Marketing Manager
Title
Name
E-mail
Telephone number:
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-
-
Mobile number:
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Contact Information - Sales
Title
Name
E-mail
Telephone number:
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-
-
Mobile number:
-
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Contact Information - Purchaser
Title
Name
E-mail
Telephone number:
-
-
-
Mobile number:
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Contact Information - Accounts Payable
Title
Name
E-mail
Telephone number:
-
-
-
Mobile number:
-
-
Business Type
Distributor
Retailer
Promotional Gift Agency
Internet
Education/Government
Other:
Products
Electronics
Home & Office
Business
Sporting Goods
Others:
How and where did you find our products?
E-mail
Newspaper Ads
Publications
Referral
Google Search (Key Word)
Other Search Engine:
Exhibition / Trade Show:
Others:
Potential Market
Consumer
Enterprise
School / College
Home & Office
Government
Lab / Factory
Small-Medium Business
Hotels/Casinos
Internet/Web Based
Others:
Terms and Conditions
I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it will be used to determine if an account can be opened. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company in order to verify the information contained herein.
I have read, and agree to abide by the terms and conditions found in the box above.
*
denotes required field
