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JB&A Division(Required)

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Company Name(Required)

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JB&A Reseller Application

JB&A only sells through the reseller channel.

JB&A is 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.

Important! You must upload a copy of your resale certificate.

Step 1 of 6

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Name of Person Completing Application(Required)

First Last

Email(Required)

Phone(Required)

How did you find us?(Required)

GENERAL BUSINESS INFORMATION

Legal Name of Company(Required)

DBA (Doing Business As)

Billing/Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Fax

Website

Years in Business(Required)

Business Ownership(Required)

Corporation

Proprietorship

Partnership

Annual Sales Volume

Estimated Monthly Purchases

Description of Business(Required)

SALES TAX EXEMPTION INFORMATION

PLEASE UPLOAD A DIGITAL COPY OF YOUR RESALE CERTIFICATE BELOW

Sales Tax Resale Number(Required)

Resale Certificate(Required)

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

BUSINESS PRINCIPALS INFORMATION

Name of Principal #1(Required)

First Last

Principal's Title(Required)

Principal's Phone(Required)

Principal's Email(Required)

Partner Portal Acces

Yes

Name of Principal #2

First Last

Principal #2 Title

Principal #2 Phone

Principal #2 Email

Partner Portal Acces

Yes

PURCHASING INFORMATION

Person Who Will Place Orders(Required)

First Last

Phone(Required)

Email(Required)

Partner Portal Acces

Yes

Send Shipping & Tracking to:(Required)

First Last

Phone(Required)

Email(Required)

Partner Portal Acces

Yes

ACCOUNTS PAYABLE INFORMATION

Name of Controller(Required)

First Last

Controller's Phone(Required)

Controller's Email(Required)

Partner Portal Acces

Yes

Accounts Payable Contact(Required)

First Last

AP Phone(Required)

AP Email(Required)

Partner Portal Acces

Yes

Preferred Delivery Address(Required)

AUTHORIZED RESELLER SIGNATURE

Digital Signature Waiver(Required)

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(Required)

First Last

Title(Required)

Signature(Required)

Date(Required)

MM slash DD slash YYYY

This field is for validation purposes and should be left unchanged.