Re-Seller Registration | Zigen Corporation

Personal Information

First Name *

Last Name *

Mobile Phone *

Email *

Title *

Are you a: *

Business Information

Business Name *

DBA *

Contact person if different

Accounts payable contact *

Sales Representative Name

Business Phone Number *

Business Address *

Address Line 2

City *

State *

Zip Code/ Postal *

Country *

Upload Credit Card Authorization Form

Drop your file here or click here to upload You can upload up to 1 files

Upload Resale/Tax Certificate

Drop your file here or click here to upload You can upload up to 1 files

Website

Business Overview

Are you the primary account owner/holder? *

How many sales people on staff

Number of installers on staff

Business Annual Sales Revenue

Annual sales revenue in conectivity products *

How many residential jobs do you install each year?

How many commercial jobs do you install each year?

Purchase Model

Purchase direct from manufacturer

Purchase from distributor

Website Login Setup

Once admin approval, you will use this information every time you shop.

User Email *

Username *

User Password *

Confirm Password *

Personal Information

Business Information

Business Overview

Purchase Model

Website Login Setup

Company

Resources

For Dealers

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