DEALER APPLICATION

Dealer requirements:

  • Each dealer must have a social security or tax ID number
  • All monthly payments for your site will be charged to your credit card automatically

Complete the following application for your own wireless accessories online store:

Company Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Order Notification Email Address:

Who will be the primary contact:
Last Name:
First Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Email:

Site information:
Do you already have a domain name:   If no, supply five choices
Existing Domain Name
or First choice:
Second choice:
Third choice:
Forth choice:
Fifth choice:
Do you have a company logo:
Information you want on the "About Us" page:
Information you want on the "Contact Us" page:
 

Payment information:
You may pay now or wait until contacted to set up your site.
Payment method:
Card Number:
Name on Card:
Expiration:

Referral Code (if any):


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