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:
* State:
* ZIP:
Country:
(please specify the country)


Company Information
Company Type:
Business Established year: Month:
* # of Employees:
* Web Site URL:
Type of operation
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 dealerbuilder
architect/interior designerelectrical contractor
home automation contractorlighting systems dealer
security system dealerstructured cabling contractor
system integratorconsultant
other