JB&A Reseller Application

Thank you for your interest in becoming a JB&A Reseller Partner.

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. When you become a JB&A reseller, you become a JB&A Partner!

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

Step 1 of 5

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Name of Person Completing Application*
First Last
Email*
Phone*
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*
Annual Sales Volume*
Estimated Monthly Purchases*
Business Ownership*
- Corporation
- Proprietorship
- Partnership
Description of Business*

BUSINESS CREDIT CARD INFORMATION
JB&A REQUIRES A CREDIT CARD ON FILE IN ORDER TO SETUP A RESELLER ACCOUNT
Credit Card Type*
Name on Credit Card*
Credit Card Number*
Expiration Date*
CID (Security Code)*
Card Signer Authorization*
- I Agree
- I Do Not Agree
I am authorized signer of the card listed and give JB&A permission to bill the credit card when verbally requested.
Signature*

SALES TAX EXEMPTION INFORMATION
PLEASE UPLOAD A COPY OF YOUR RESALE CERTIFICATE BELOW
Sales Tax Resale Number*
Resale Certificate File*
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
- Send invoices by US Mail
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*

Contact our experts to find out how we can help your business today.

Contact JB&A

'Building Business Relationships'

JB&A Reseller Application

Thank you for your interest in becoming a JB&A Reseller Partner.

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

Step 1 of 5

GENERAL BUSINESS INFORMATION

BUSINESS CREDIT CARD INFORMATION

SALES TAX EXEMPTION INFORMATION

BUSINESS PRINCIPALS INFORMATION

PURCHASING INFORMATION

ACCOUNTS PAYABLE INFORMATION

AUTHORIZED RESELLER SIGNATURE

Contact our experts to find out how we can help your business today.