Reseller Application

Online Business Registration
COMPANY INFORMATION
Company:	Contact Name:
Street Address:	Contact Phone:	Ext:
Street Address:		Click on all that applies below:
Apt. or Suite:	*() We are a:**
City:	Other:
State:	*() If a Dist., Wholesaler or Mfg.: List the Brands below:**
Country
Zip:
Telephone:	Federal ID #:
Fax:	Tax Exempt # :**
E-Mail:	**FL Business must fax the current Florida Tax Exempt Form
	*() If an Auth. Warranty Service Agent: List the Brands below:**


Our Customer Number is: Check our Account, because: Just moved Verify Inf. Re-classify
I do not know my Customer Number and we purchased from you before, Please review our information
Note: If you are placing an order for the first time, provide The Order Number given by the system:
The above information is for our business classification and shipping purposes only, it will assist us in providing your discounts. Guillen's enterprises, Inc. reserves the right to refuse any orders. **Fax (305) 223-4420