WiLife Reseller Application

*All fields in the application form must be completed for consideration

Company Information 

Company DBA Name:
Primary Contact:
Salutation: First Name: Last Name: Title:


Year Established: Number of Locations: Federal Tax ID #

Business and Marketing Profile 
Primary Business Classification:
In which state(s) do you actively sell?
Hold Ctrl to select more than one.
Do you sell products on line? 
Please describe your major product focus:
Sales dollars from Homeowners: %, Businesses: % (Must add up to 100%)
Where do your sales dollars primarily come from?
Do you sell video security products?
If yes, number of analog systems sold per month:
If yes, number of IP/Network systems sold per month:
How did you hear about WiLife?
Have you used WiLife before?
Technology Focus  Experience Level in PCs and Networks:
Marketing and Sales Plan  What is your expected volume of WiLife systems sold per month?
Minimum quarterly purchase volume to qualify for 8% distributor discount: 20 Starter Kits and/or Add-on Cameras)
I commit to the required quarterly purchase: 20 units (Starter Kits or Add-On Cameras).
I commit to the required intitial purchase: 10 units (Starter Kits or Add-On Cameras).
Initial purchase timetable:
How do you plan to market/sell WiLife?

Product Buying Model  Distributor accounts:
Hold Ctrl to Select more than one.
If you have a distributor account please fill in the following:
D&H Representative:
 D&H Account Number:
Ingram Micro Representative:
 Ingram Micro Account Number:
EMJ/Synnex-Canada Representative:
 EMJ/Synnex-Canada Account Number:
Tech Data Representative:
 Tech Data Account:
Please list any other distributor account(s):

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