Application

Please complete the fields below to become an authorized dealer. Once we have received your information, we will review your application and once approved, we will contact you with confirmation to this effect. Once your username and password have been added to our system, you will be able to log in to make purchases with a dealer discount and have access to other dealer specific information and resources. We appreciate your interest in becoming a CLO Systems partner and please feel free to contact us with any questions. Thank you from the entire CLO Systems team. Fields marked with * are required. You can also complete this form and fax it to us if you prefer. Fax: (626) 939-3378

Your Name: *

Company: *

Your Title: *

Address 1: *

Address 2:

City: *

State or Province: *

Zip or Postal Code: *

Country if other than the U.S.:

Your Email: *

Fax: *

Phone: *

Cell Phone:

Website: *

Year established: *

Number of years in business: *

Number of Employees: *

Annual Sales: *

Resales/Tax No.:

SS# or F.E.I.N.:

DUNS #:

Seller's Permit Number: *

Please check the box that best describes your business: *
Industrial/Commercial Dealer
Retail Store
Consumer/Retail Distributor
Consultant
Home Theater Dealer
Exhibit Manufacturer
OEM (Original Equipment Manufacturer)
Other (Please explain below)

If you checked Other above please explain:

Agreement:I hereby agree to not resale the products purchased from CLO Systems LLC. to any on-line stores. I also certify that I hold a valid seller's permit issued pursuant to the Sales and Use Tax Law. Furthermore, I acknowledge the tangible personal property described herein which I shall purchase from CLO Systems LLC. will be sold to me in the form of tangible personal property. It is understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property or other authorized amount. *
I have read the agreement and agree to follow the terms.
I do not agree.

Signature: Please type your full name here. *

Requested Username: *

Requested Password: *

How did you hear about our dealer program? *
AVSforum.com
Expo (CES, CEDIA, etc)
Print (Magazine, Newspaper, Periodicals)
Friend, Colleague, Client, word of mouth etc.
Other website like ebay, amazon, topgearelectronics, motorizedmount, etc..
RemoteCentral.com
Search Engine like Google, Yahoo, MSN, etc.

Include any other comments or specific inquiries that you might have at this time:

Attach Files: If you need to attach any files do so here