Reseller Registration – Securus Inc.

Please complete the information below and click Register. Be sure to carefully read the Terms of Use before submitting. A member of the Team will contact you after reviewing your registration to provide you additional information to get started selling America’s #1 pet protection services – SpotLight GPS Pet Locator and SpotLite GPS Pet Locator.

Account Details :

	* EmailID :
	* Password :

	* Confirm Password :
	* I am Interested In :
	* Password Reminder Question :
	* Answer :

Payment Details :

Name/Registered Company Name :
Address Line1 :
Address Line2 :
City :
State :
ZIP Code :
* Telephone Number :	- -
Fax :
* Email :
Website URL :
Company Type :
Name(s) of Owner(s) :
Years In Business :
FEIN :
State Sales Tax License :
Dun and Bradstreet Number :

Bank Reference :

	Bank Name :
	Address Line1 :
	Address Line2 :
	City :
	State :
	ZIP Code :
	Telephone Number :	- -
	Fax :
	Contact Person :
	Account Number :

Trade References :

	Business Name :
	Contact Person :
	Address Line1 :
	Address Line2 :
	City :
	State :
	ZIP Code :
	Telephone Number :	- -
	Fax :

	Business Name :
	Contact Person :
	Address Line1 :
	Address Line2 :
	City :
	State :
	ZIP Code :
	Telephone Number :	- -
	Fax :

	Business Name :
	Contact Person :
	Address Line1 :
	Address Line2 :
	City :
	State :
	ZIP Code :
	Telephone Number :	- -
	Fax :

Buyer Contact Details :

	* First Name :
	Last Name :
	Street :
	City :
	State :
	ZIP Code :
	Telephone Number :	- -

	I agree to the terms of service

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