Dealer Application

Please fill out all fields.

This form is used by dealers and integrators who resell and install security equipment to apply for dealer pricing from Clinton Electronics.

We do not supply pricing to end-users. If you are an end-user, please click here and we will help you locate a dealer in your area.

Name*
First Last
Title
Company Name*
Website
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
International Phone Number*
What prompted you to apply to become a dealer?
- Send me a catalog!
Business Information
Doing Business As (If Applicable)

Please fill out this field if you are using a D.B.A., or Doing Business As, rather than your legally registered company name.
Business Registration Number*

Please provide a Tax ID Number, EIN or Canadian BN Number
Years In Business*
Number of Employees*
Estimated Annual Sales*

Please provide an estimate of total (gross) annual revenue for your entire company, not just within the verticals we supply.
Payment Preferences*
- Net 30 Terms
- Credit Card Only
Accounts Payable Contact
First Last
Accounts Payable Email
Is your company an LLC?*
Select Yes if your company is formed as a Limited Liability Company or Limited Liability Partnership.
Trade References (4 Required)
You are being asked for Trade References because you chose Net 30 terms. If you'd like to proceed without references, please choose Credit Card Only for Payment Preferences above.
Trade Reference 1 Company Name*
Trade Reference 1 Company Account #
Trade Reference 1 Email Address*
Trade Reference 1 Fax Number
Trade Reference 2 Company Name*
Trade Reference 2 Company Account #
Trade Reference 2 Email Address*
Trade Reference 2 Fax Number
Trade Reference 3 Company Name*
Trade Reference 3 Company Account #
Trade Reference 3 Email Address*
Trade Reference 3 Fax Number
Trade Reference 4 Company Name*
Trade Reference 4 Company Account #
Trade Reference 4 Email Address*
Trade Reference 4 Fax Number
LLC Payment Guarantor
In consideration for Clinton Electronics Corp. extending credit to the business identified below for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual hereby personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to Clinton Electronics Corp. by the business identified below whether said sums are due under open account, contract or otherwise.

It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as stated in the credit agreement between Clinton Electronics Corp. and the business.

Clinton Electronics Corp. shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by Clinton Electronics Corp. Said notice shall specify the date on which this guaranty is to be terminated; said date not to be less than seven days after such notice is received. Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination.
Name of Business Whose Account is Guaranteed
Name of Person Guaranteeing Payment*
First Last
Guarantor's Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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Dealer Application

Please fill out all fields.

Business Information

Trade References (4 Required)

LLC Payment Guarantor