Reseller Application Form

Company Information

Company Name
Subsidiary of
Address
Address
City
State
Zip
Country
email
Phone
Fax

Tax Information

Organization Type
Business Category
Resale / Sales Tax Number
Federal EIN
Years in Business

Principals

Name
Title
Phone

Name
Title
Phone

Billing Information

Requested Payment Terms
Contact Name
Address
Address
City
State
Zip
Country
email
Phone
Fax

Shipping Address

Same as Billing

Address
Address
City
State
Zip
Country

Trade References (four required)

Company Name
Address
City
State
Zip
Phone
Fax

Company Name
Address
City
State
Zip
Phone
Fax

Company Name
Address
City
State
Zip
Phone
Fax

Company Name
Address
City
State
Zip
Phone
Fax

I would like to receive emails from Cable Solutions about Special Promotions and Sales.

I authorize Cable Solutions to investigate and verify the information I have provided herein. I authorize and instruct any person or reporting agency to compile and furnish to Cable Solutions information that it may have to obtain in response to such inquiries and agree that such information shall remain Cable Solutions property.

I agree to honor all MAP (Minimum Advertised Price) policies that may be in effect by each manufacturer we elect to represent.

I attest to financial responsibility, ability and willingness to pay invoices in accordance with the Requested Terms.

I certify that all statements made by me in this application are correct to my knowledge.

Your name: Title: Date:

Cable Solutions will not sell or give personal information, including email addresses to any outside entity without the permission of the above named authorized contact. Please click here to read our complete Privacy Policy.