Become a Dealer

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Business Name * Attention! Please enter the correct information below. Missing/incorrect information will cause delay or failure on your orders.
Business License # / Business Certificate # *
Contact Name * (First Name)
Contact Name * (Last Name)
Phone *
Email * Important! Please make sure you put a valid email address! Otherwise, you will not be able to receive important information or retrieve log-in information when necessary.
Business Address *
Suite #
City *
State *
Zip Code *
Store Type *
Sign Up for Products Interested *

Lead from / Local Sales Person (Such as independent whole-seller)

Sales Person Name (If you have one)
Phone
Email

Account Information

Desired User ID*
Desired Password*

Select desired account type

  I would like to sign up as a Prepaid Account. (Reload fund as you use)
    * Provide us W-9, Tax ID (Forms can be provided after account created)
  I would like to sign up as a Credit Account. (ACH debit from your bank account)
    * Provide us W-9, Tax ID, Government ID, and ACH form.(May require Bank Reference)
   (Forms can be provided after account created)
  Note, We can convert account type at any time.
    *Default setup is Prepaid Account.