Reseller Application

US Digital Media, Inc. welcomes applications from Reseller/Distributors and High Volume Users. Please fill out the form to apply for exclusive high volume pricing.

* Denotes Required Field

Company Contact Information

*First Name:

*Last Name:

*Company:

*Address:

*City:

*State:

*Zip:

*Country:

*Phone:

Fax:

*E-Mail:

Website URL:

Billing Address (If different from address)

Address:

City:

State:

Zip:

Country:

Other Company Contacts If different from above

President/CEO

Phone

Sales Manager

Phone

Purchasing Manager

Phone

Business Category (check all that apply) *

Reseller	Retail/Storefront	Other (specify below)
VAR	Representative
High Volume User	Government Agency

Annual Sales *

Market Focus (check all that apply) *

Government	Education	Business Services
End user/retail	Small Business	Medium Business
Large Corporations	Manufacturers	Other (specify below)

Product Interest (check all that apply) *

How did you hear about us?

Your comments:

US Digital Media respects your privacy. We want to make use of individual identifying-information that you provide to us for purposes of serving you better.

US Digital Media does not make individual identifying-information available to third parties for marketing purposes.

Thank you for submitting your application to our wholesale disbributors/resellers program. Someone will be contacting you shortly regarding your application.

Headquarters

1929 West Lone Cactus Drive
Phoenix, Arizona 85027
United States

Map

Local (623) 587-4900
Toll Free (877) 992-3766
Fax (623) 587-4920

Wholesale Distribution

Contact us at
reseller@usdigitalmedia.com
Toll Free (877) 992-3766