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ID TAX/Vendor-Reseller #
Legal Company Name:  
Operating Name if Different:
Address: 
City: 
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Country:
Zip Code/Postal Code:
Phone Number:  
Fax Number:
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Website:  

Year(s) in Business:

Number of Employees:
Installations: Store Front:
Contacts:  

Sales:

Marketing:

Purchasing:

Others:

Authorized Dealer for:   
DirecTV              Hughes
ExpressVu        StarChoice
Dish Network  		 Sizes of dishes you sell:
18inch   24inch     30inch      36inch   40inch     StarBand
DirecPC DirecDuo
DirecTV Plus   Dish Network 500
Job Description: Approx. number of systems sold per month: 
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