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Become A Reseller

 
   To become an Envive Authorized Reseller, Please fill out the form below OR print and fax (972-242-3242) us a completed form using the downloadable application.
PRINTABLE APPLICATION (Part 2 of 2)
 WARNING: PDF. Adobe Acrobat is required to view the document.
 

ONLINE APPLICATION
** All Fields are Required **

COMPANY NAME :
State Dealer License # :
Reseller Tax ID:
DBA (If Applicable) :
Shipping Address :
City :
State :
Zip :
Billing Address:
City:
State:
Zip:
PRIMARY CONTACT:

(First name) :
(Last Name) :
Title :
Email Address :
Phone :

Extn :
SECOND CONTACT:

(First Name) :
(Last Name) :
Title :
Email :
Phone :

Extn :

YOUR COMPANY INFO:

Fax Line :
Website :
What other Product Lines do you carry?
What is your Primary Business focus?
Describe your target customer:
 
What Geographical areas does your business service?
What services does your company perform?
(Check all that apply)
Network Design
Install Service
Home Automation
Home Alarm
Home Lighting
Other
Number of Years in Business:
Number of Employees:
Sale Force:
Previous annual sales:
Projected Sales:
Credit Line (requested):

REFERENCES (BANK/CREDIT/TRADE):

(1) ORGANIZATION:
Account #:
Contact Name:
Phone:
Address:
City:
State:
Zip:
(2) Organization:
Account #:
Contact Name:
Phone:
Address:
City:
State:
Zip:
(3) Organization
Account #:
Contact Name:
Phone:
Address:
City:
State:
Zip:
Please note that selecting 'I Agree' gives Envive Inc. consent to contact the references and request financial information you provide above.
I Agree
Name:
Title:
Date: