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Type of Business * Choose... Sole Proprietorship Corporation Partnership Other

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Are your sales tax exempt? If you fax copy with application. Yes No

Authorized Purchasers?

How did you find KJB Security Products? * Please select ... Search Engine Social Media Via Email World Wide Brands Wholesale Central Flea Market Zone (west) Flea Market Zone (east) Website Link ISC East Show ISC West Show CES Show Other Trade Show Security Products Magazine Printed Ad Business Associate Customer Reference Friends Reference Other

If Other is selected, please specify

Which Product Line are you most interested in reselling? * Please Select ... Zone Shield Xtreme Life iTrail GPS SGHome (Home Automation) LawMate All Products Not Sure

How soon do you need to make your first purchase * Please select ... NOW within 1 week within a month 3 - 6 months

You Would Describe Your Company As? * Please Select ... Retail Spy Store Other Retail Store Internet Retailer Catalog Retailer Master Dealer Website Customer Private Investigator Investigator Government: Law Enforcement Government: Other Taxi Company Exporter OEM Manufacturer/Wholesaler Cash Sale Competition

Number of Employees * Please select ... 1 - 3 3 - 5 5 - 10 10 - 20 20+

Annual Gross Sales * Please select ... less than 100k 101k - 300k 301k - 500k 501k - 750k 751k - 1million 1 - 5million 5 - 10million 10 - 50million more than 50 million

Majority of Sales Come From * Please select ... Walk-Up Retail E-Commerce Site Catalog Sales Other

If Other is selected, please specify

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A/P Contact

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If not you, who should we contact to help setup your account

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