Become a Reseller - Anti Theft Devices for Retail

First name*

Last name*

DBA Business Name

Email*

Phone

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have a Reseller Certificate*

Do you sell products in physical locations?*

Number of Kiosks

Number of Stand Alone Locations

Do you Sell Online?*

If so, list all websites, online storefronts, etc. Separate by comma.

Do you sell on Amazon, Ebay, Alibaba, or similar websites?*

List all applicable reseller account numbers, with reference to each website, separated by commas

Do you purchase from a distributor?*

If so, list all Distributors you purchase from. Separate by comma.

Name

This field is for validation purposes and should be left unchanged.