Become a Customer Partner

First Name

M.I.

Last Name

Job Title

Contact Email

Legal Business Name

Tax ID / Tax I.D. #

Street Address

Address Line 2 (Optional)

City

State / Territory / Region

Postal / ZIP Code

Business Phone

Operating Country / Market United States (Miami Hub) Jamaica Dominican Republic Haiti Panama Curaçao Suriname Guyana Other Caribbean / Americas Territory

Type of Business Electronics Retailer Sub-Distributor / Wholesaler Telecom Operator / MVNO System Integrator E-Commerce Merchant Enterprise Consumer

In Business Since (Year)

Business Website

• Corporation (Inc / LLC)
• Partnership
• Proprietorship

• Is this entity a division or subsidiary of a parent company?

Name of Parent Company

Parent Company In Business Since

Principal #1 – Full Legal Name

Principal #1 – Title

Principal #1 – Residential or Executive Address

Principal #1 – Direct Phone

Principal #2 – Full Legal Name (Optional)

Principal #2 – Title

Principal #2 – Address

Principal #2 – Direct Phone

Primary Authorized Purchaser – Full Name

Primary Authorized Purchaser – Work Email

Primary Authorized Purchaser – Direct Phone

Primary Authorized Purchaser – Extension

Secondary Authorized Purchaser – Full Name (Optional)

Secondary Authorized Purchaser – Work Email

Secondary Authorized Purchaser – Direct Phone

Secondary Authorized Purchaser – Extension

• Yes
• No (Prepaid)

Financial Officer / Controller

Finance Email Address

Last Annual Sales (USD)

Requested Credit Line (USD)

Payment Terms Requested Net 30 Days Net 15 Days Net 45 Days Prepaid / Wire In Advance

AP Contact Person

AP Dedicated Invoicing Email

AP Direct Phone

AP Extension

• Send automatic electronic invoices, airway bills, and shipping manifests to this AP email address

Financial Institution Name

Bank Officer / Contact Name

Checking Account #

Branch City / Country

Bank Officer Phone

Domestic Trade Reference – Supplier Company Name

Domestic Trade Reference – Credit Department Contact

Domestic Trade Reference – Phone

Domestic Trade Reference – Account Since

Domestic Trade Reference – Credit Limit

Domestic Trade Reference – Current Balance

Foreign Trade Reference – International Supplier Name (Optional)

Foreign Trade Reference – Contact Officer & Email

Accepted formats: PDF, JPG, PNG. Maximum file size: 10 MB per file.

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• I confirm that I am an authorized corporate officer and that all submitted details are accurate.