Digital Supply International

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Reseller Application

DSI Partners

Reseller Application Form
(* denotes required field)
*BUSINESS NAME (DBA) :**
ADDRESS *:
*CITY :**
STATE *:
ZIP *:
PHONE *:
FAX :
OTHER :
*EMAIL :**
WEBSITE
DATE BUSINESS STARTED:
FED ID#:
RESALE CERTIFICATE# :
TYPE OF ORGANIZATION:
COMPANY CONTACTS (provide name, title and contact information):
MARKETING :
SALES :
PURCHASING :

TOTAL # OF EMPLOYEES:
ESTIMATED YEARLY SALES VOLUME OF PHOTO-ID EQUIPMENT AND SUPPLIES?

PLEASE INDICATE WHICH OF THE FOLLOWING MARKETS YOU SERVE:

PLEASE LIST THE DATACARD PRODUCTS YOU WISH TO RESELL:

CREDIT APPLICATION:
COMPANY :
ADDRESS :
CITY :
STATE :
ZIP :
PHONE :
FAX :
DATE BUSINESS STARTED :
DUNS ID#:
PRINCIPAL OWNER:
BANK REF:
ADDRESS:
CITY:
STATE:
ZIP:
CONTACT NAME:
CONTACT PHONE:
LIST 3 TRADE REFERENCES (include address, phone#, fax#, acct# and a contact person):
TRADE REF 1:
TRADE REF 2:
TRADE REF 3: