Reseller Application

Geographics Customers, please login before completing this form.
The fields will be populated with the existing data from your account.

Fill out the below application and click Submit.
You will receive an automatic confirmation e-mail.
Your application will be checked and an e-mail response will be sent to you within 24 business hours. If you are in a rush, please call us.
Once your application is approved you can login with the same email and password to take advantage of discounts

For questions or assistance, please call 203-644-1271; (800)-436-4919 or email to reseller@geographics.com.

Contact Information

First Name:^*

Last Name:^*

E-mail Address^*

Confirm E-mail^*

Password:^*

Confirm Password:^*

Company

Company Name^*

Doing Business As (DBA)^*

Date Business Started^*

Federal Tax ID #^*

Billing Address

First Name:^*

Last Name:^*

Street Address^*

City^*

Zip Code^*

State^*

Country^*

Phone Number^*

Shipping Address

Same as Billing Address:

First Name:^*

Last Name:^*

Street Address^*

City^*

Zip Code^*

State^*

Country^*

Phone Number^*

Fax Number

Store Details

Sales Activity^*

Online/Web Sales, Only

Brick & Mortar Store(s), only

Online & Retail/Wholesale Store(s)

Web Store Address 1^*

Web Store Address 2

Web Store Address 3

Store Description^*

Retail/Wholesale Location

Same as Shipping Address:

Street Address^*

City^*

Zip Code^*

State^*

Country^*

Phone Number^*

Fax Number

Business

Years in Business^*

Type of Business^*

Wholesale

Retail

Manufacturing

Incorporation State^*

Incorporation Country^*

Company Owner^*

Authorized Buyer(s)

Authorized Buyer 1 Signature (Print Name)^*

Authorized Buyer 2 Signature (Print Name)

Reseller Application

Contact Information

Company

Billing Address

Shipping Address

Store Details

Retail/Wholesale Location

Business

Authorized Buyer(s)

Verify security code