Become ResellerJBA2021-10-09T10:23:45-07:00

Exertis Broadcast Reseller Application

Thank you for your interest in becoming an Exertis Broadcast Reseller Partner.

Exertis Broadcast (formerly JB&A) only sells through the reseller channel.

We are dedicated to building long lasting value add business relationships with our reseller partners, providing the best customer service in the industry, unique solutions and complete workflows, followed by the best training in the industry.

To become a Reseller Partner, please complete the application below including a copy of your resale certificate.

Step 1 of 6

Name of Person Completing Application*
First Last
Email*
Phone*
How did you find us?*

GENERAL BUSINESS INFORMATION
Legal Name of Company*
DBA (Doing Business As)
Billing/Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Website
Years in Business*
Business Ownership*
- Corporation
- Proprietorship
- Partnership
Annual Sales Volume
Estimated Monthly Purchases
Description of Business*

SALES TAX EXEMPTION INFORMATION
PLEASE UPLOAD A COPY OF YOUR RESALE CERTIFICATE BELOW
Sales Tax Resale Number*
Resale Certificate File*
Upload FileAccepted file types: jpg, png, pdf, Max. file size: 5 MB.
BUSINESS PRINCIPALS INFORMATION
Name of Principal #1*
First Last
Principal's Title*
Principal's Phone*
Principal's Email*
Name of Principal #2
First Last
Principal #2 Title
Principal #2 Phone
Principal #2 Email

PURCHASING INFORMATION
Person Who Will Place Orders*
First Last
Phone*
Email*
Send Shipping & Tracking to:*
First Last
Phone*
Email*

ACCOUNTS PAYABLE INFORMATION
Name of Controller*
First Last
Controller's Phone*
Controller's Email*
Accounts Payable Contact*
First Last
AP Phone*
AP Email*
Preferred Delivery Method*
- Send invoices by email
Preferred Delivery Address*

AUTHORIZED RESELLER SIGNATURE
Digital Signature Waiver*
- I Agree
- I Do Not Agree
As duly authorized signer for my company, I affirm that all of the information submitted in this form is accurate.
Signer Name*
First Last
Title*
Signature*
Date*
MM slash DD slash YYYY
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