Reseller Application

Becoming a reseller with us is very simple. Please fill out the form below and a sales representative will be in touch with you within 2-3 business days.

Legal Company Name

Trade Name

Primary Contact Name

Billing Address Line 1

Billing Address Line 2 (Optional)

Postal/Zip Code

Phone Number

Fax Number

Email Address

Website

Years in Business

Business/GST Number

PST Number

Name/Title

Phone

Same as Authorized Buyer

Name

Phone

Email for Invoices & Statements

Credit Card Trade Reference

Legal Company Name

Primary Contact Name

Billing Address

Postal/Zip Code

Phone Number

Fax Number

Email Address

Credit Amount Requested

Credit Terms

D&B Duns Number

Customer agrees to pay all invoices in full and within terms agreed upon.

Customer's failure to make timely payment may result in such action as commencement of proceedings for collection, revocation of credit, stoppage of shipment, delay or cessation of future deliveries, repossession of unpaid delivered goods.

Notwithstanding any "net" payment provisions specified on the invoice, ATLANTIA HOLDINGS INC. shall have no continuing obligation to deliver products on credit, and any credit approval may be withdrawn by ATLANTIA HOLDINGS INC. at any time

Once Customer has taken delivery of any goods these terms shall apply to all subsequent orders from the customer.

Customer will not re-sell or advertise any product purchased from Atlantia on any third party website. Third party websites include, but are not limited to, Amazon, Ebay or Best Buy Marketplace.

By checking this box, the customer warrants and represents that the information contained herein is true and correct. Terms and Conditions have been read and agreed upon.

Notes

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Reseller Application

Company Information

Authorized Buyer

Accounts Payable

Payment Method

Payment Terms

Terms & Conditions