Vetra Systems International Reseller Online Application Form

Vetra Systems Reseller Application (outside the US)

Thank you for your interest in becoming a Vetra Systems Reseller. Please read the important requirements and complete the application below.

Important Requirements:
1) If your business is a general / limited partnership or sole proprietorship, please complete the information in Section 3 of this form.

SECTION 1:

Business Trade Name or DBA:
Business Legal Name:
Billing Information:
Bill to Address 1:
Bill to Address 2:
Bill to City:
Bill to State:
Bill to Province or County:
Bill to Country:
Bill to Postal Code:
Shipping Information:
Leave blank if the same as above:
Ship to Address 1:
Ship to Address 2:
Ship to City:
Ship to State:
Ship to Province or County:
Ship to Country:
Ship to Postal Code:
Contact Information:
Primary Contact Name:
Primary Contact Phone Number:
Primary Contact Fax Number:
Company Website URL:
Primary Contact Email:

Type of Business:
SECTION 2:
Payment Terms and Bank Information:
Payment Terms:	Credit Card Prepay Bank Transfer
Name of Business Bank:
Bank Address 1:
Bank Address 2:
Bank City:
Bank State:
Bank Province or County:
Bank Country:
Bank Phone Number:
Account Officer Name:
Bank Account Number:

SECTION 3:
Leave blank if Type of Business is Corporation
Owner or Partner 1 Name:
Owner or Partner 1 Phone Number:
Owner or Partner 1 Email Address:
Partner 2 Name:
Partner 2 Phone Number:
Partner 2 Email Address:

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VETRA Systems Corporation
275 Marcus Blvd. Suite J Hauppauge, NY 11788-2022 USA
Toll Free 1-800-537-9296
Tel: 631-434-3185 Fax: 631-434-3516 e-mail: sales@vetra.com