Online Reseller Application

Reseller Name *
Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Fax - (###) - ### ####
Email *
How long have you been in business? *
Type of Reseller * Online Only Click & Mortar Brick & Mortar Kiosk Other
How many locations do you have? *
What distributors do you purchase from? Mark all that apply. * Tessco Xentris C5 Just Mobile Warehouse Other None
Are you interested in becoming a BodyGuardz Certified Installer? * Yes No
If yes, how many Certified Installers will you have on your staff?
EIN Number *
Sales Tax Exempt # *
Annual Sales * Less than 1M 1M - 10M 10M - 50M Greater than 50M