Dealer in Virginia State customer must fill out the
VA State Resale Certificate
and fax it back to (703) 997-8779.
Contact Information (
*
required fields)
*
Company Name:
GSS sales Representative:
*
How did you hear about us?
*
Tax Identifier:
(xx-xxxxxxx)
*
First Name:
*
Last Name:
Title:
*
Telephone:
*
Email:
Prefer Contact:
Phone
Email
*
Address 1:
Address 2:
Address 3:
*
City:
*
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Outside US
*
ZIP:
Country:
USA
Others
(please specify the country)
Company Information
Company Type:
Sole Proprietorship
Corporation
S-Corporation
Limited Liability
Company LLC
Joint Venture
General Partnership
Limited Partnership
Non-Profit Corporation
Business Established year:
Month:
*
# of Employees:
*
Web Site URL:
Type of operation
Wholesale
Retail
E-commerce
Principle geographic coverage radius in miles
*
Have you ever installed any electronic security products before:
Yes
No
if yes, please specify the Brand Name:
How is your business classified? (check all that apply)
audio/home theater dealer
builder
architect/interior designer
electrical contractor
home automation contractor
lighting systems dealer
security system dealer
structured cabling contractor
system integrator
consultant
other