Videointegrators USA Reseller Registration Form
To comply with United States of America IRS regulations, we kindly ask you to please register your company before sending any payments.
Registered Business Name *
Your answer
DBA
Your answer
Full Business Address *
Address, suite/apt/etc, City, State, Zip Code, and Country
Your answer
Country *
How long has the Business been at the current address? *
Your answer
Telephone Number *
Your answer
Date Business commenced *
MM
/
DD
/
YYYY
Which category does the Business fall under? *
Tax ID (FEIN #) *
Your answer
Website *
If not applicable please write n/a.
Your answer
Social Media Accounts *
Please provide us with links to your social media accounts (Facebook, Twitter, Instagram, LinkedIn). If none are available please write n/a.
Your answer
Contact Name (Accounts Payable) *
Your answer
Email Address (Accounts Payable) *
Your answer
Contact Name (General Manager) *
Your answer
Email Address (General Manager) *
Your answer
Who should receive product costs and discount information? *
Special "Bill to:" Notes *
Information such as Tax ID, Company Department, Contact Person for deliveries, etc.
Your answer
Preferred Method of Payment *
Please select all that apply. If selecting Credit you must also select a payment preference (Wire Transfer, Credit Card, Checks, ACH).
Required
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