Reseller Application

Name of business

Please enter the name of your business

Contact person

Please enter the name of the contact person within your business

Position

Please enter your position within your business

Please enter the email adress of your business

Phone

Please enter the telephone number of your business

FAX

Please enter the FAX number of your business

Address

Please enter the address of your business

City

Please enter the city in which your business is located

Zip code

Please enter the zip code of your business

Country

Please enter the country in which your business is located

Business registration number

Please enter the business registration number of your business

Value added tax ID number

Please enter the value added tax ID number(EU) of your business

UPS Hardware UPS Software Battery Management BACS Facility Management

Yes No

Your company's turnover in the last year of UPS or battery products

Please enter your business's turnover of UPS or battery products

Estimated turnover for GENEREX products

Please enter your estimated turnover for GENEREX products

Credit institue

Please enter the credit institute of your business

Account number

Please enter the account number of your business

Bank location

Please enter the location of the bank of your business

If you qualify, you will be able to place orders with a 30 days payment date.
Non-qualifying applicants must pre-pay by bank transfer or credit card before delivery.