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New Account Application

Welcome to the Account Application for a registered account with Visol Products.
This account is intended for retailers or drop-ship only resellers who would like to order our products at extremely low wholesale prices.
To get an account for you or your business, please fill out the information sheet below.
After you have finished this, please send a faxed copy of your retailer’s license to us at 214-291-5664.
If you have any questions regarding the application or would like to apply for an account by fax, do not hesitate to Contact Us.

Billing Address

Your order may be delayed if this does not match the address your credit card statement is mailed to.

	* Required Fields
Are you a retailer :	YesNo
Do you have a Reseller Permit (Tax ID#)? :	YesNo
Are you a drop-ship only retailer :	Click Box If Yes
Company :
* First Name :
* Last Name :
* Phone :
Fax :
Business Type :
* Address 1 :
Address 2 :
Suite :
* City :
* Country :
* State :	If other, please specify
* Zip :

Shipping Address

Check this box if billing and shipping addresses are the same.

	* Required Fields
Company :
* First Name :
* Last Name :
* Phone :
Fax :
Business Type :
* Shipping Address 1 :
Shipping Address 2 :
Suite :
* City :
* Country :
* State :	If other, please specify
* Zip :

Email and Password

	* Required Fields
* First Name :
* Last name :
* EMail :
* Password :
* Confirm Password :
I am Over 13 years Old:
Would you like to receive our monthly email with exclusive web specials and detailed product information? :YesNo

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