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Personal Information

First Name

Last Name

Sign-in Information

Password

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Additional Information

Thank you for your interest in becoming a Broadcast USA reseller. Please fill out the reseller application form. The review and decision process can take up to 15 days. You will be notified once a decision is made.

Become a Reseller

Broadcast USA is always on the lookout for motivated companies that recognize the value of the manufacturers and products we bring to the video marketplace. If you would like to become an authorized Broadcast USA reseller, please complete the following form.

The submission of this application does not warrant or guarantee approval to become an authorized reseller for any of the manufacturers that Broadcast USA represents. Once your application is submitted, it will undergo an approval process to verify whether your company meets and can sustain Broadcast aUSA"s reseller criteria. The review and decision process can take up to 15 days. All applicants will be notified once a decision has been made.

This application is designed to obtain information about your company for reseller approval. This information is strictly confidential, and will be used only in the alliance between Broadcast USA and your company. At the conclusion of submitting this form, you will be asked to attach a copy of your current financials, a copy of your certificate of incorporation, a picture of your brick and mortar store front, and any other relevant documents you deem appropriate.

Please note, without attachment of proper documents this application will not be processed.

Business Information

Phone Number:

Have you done business with Broadcast USA before?

If yes, what was your business identity?

Legal Business Name:

Company Name:

Company DBA:

Address:

City:

State

Zip Code:

Resale Certificate#:

Resale Certificate State:

Resale Certificate Expires:

W-9 Tax ID Number:

Federal EIN Business ID:

Years in Business:

Number of Employees:

Type of Business:

Legal Business Formation:

Have you or any of your affiliates filed bankruptcy?

If yes, what state and Year:

Is your company EDI Capable?

Applicant Information

Owner/Partner/ Officer First Name:

Last Name:

Title:

E-Mail:

Phone Number:

Mobile Number:

Other Owner/Partner/ Officer First Name:

Last Name:

Title:

E-Mail:

Mobile Number:

Sales Person First Name:

Last Name:

Title:

E-Mail:

Phone Number:

Mobile Number:

Other Sales Person First Name:

Last Name:

Title:

E-Mail:

Phone Number:

Mobile Number:

Trade References

Trade Reference Business Name:

Contact:

Phone Number:

E-Mail:

Relationship to applicant:

Years working with applicant:

Trade Reference Business Name:

Contact:

Phone Number:

E-Mail:

Relationship to applicant:

Years working with applicant:

Trade Reference Business Name:

Contact:

Phone Number:

E-Mail:

Relationship to applicant:

Years working with applicant:

Trade Reference Business Name:

Contact:

Phone Number:

E-Mail:

Relationship to applicant:

Years working with applicant:

Bank References

Bank Reference / Bank Name

Account Number:

Address:

City:

State:

Zip Code:

E-Mail:

Phone Number:

Billing Information

Billing Address

City:

State:

Zip Code:

A/P Contact First Name:

A/P Contact Last Name:

Phone & Extension:

E-Mail:

Shipping Information

Shipping Address:

City:

State:

Zip Code:

Shipping Contact:

Shipping Phone & Extension:

E-Mail:

Invoice Method Preference:

Do you use Quickbooks to create your purchase orders ? (check for yes).

Document Download

PLEASE COMPLETE REQUIRED DOCUMENTS

Broadcast USA Credit Card Form

Broadcast USA Reseller Agreement

Personal Guaranty

For applicants seeking net terms only

Net Terms application

Document Upload

Certificate of Legal Business Entity

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Certificate of Resale

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Company Financials

pdf,zip,doc,docx,png,jpg

Broadcast USA Reseller Agreement

pdf,zip,doc,docx,png,jpg

Credit Card form:

pdf,zip,doc,docx,png,jpg

Personal Guarantee

pdf,zip,doc,docx,png,jpg

Picture of your store front

pdf,zip,doc,docx,png,jpg

Net Terms Application

pdf,zip,doc,docx,png,jpg

FedEx account

BECOME A

RESELLER

Create New Customer Account

Thank you for your interest in becoming a Broadcast USA reseller. Please fill out the reseller application form. The review and decision process can take up to 15 days. You will be notified once a decision is made.

Become a Reseller

Company Information

Business Information

Applicant Information

Trade References

Bank References

Billing Information

Shipping Information

Document Download

Document Upload

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