HeadlightSticker™ Dealer Application

HeadlightSticker™ products are distributed through our network of certified dealers. Certified dealers must be professional, licensed installers in their state of operation.

Approval process time may vary. To expedite approval, you can send us the following documents:
- Contractor or Installer License
- State Resale Certificate
- W9
This program is intended for professional installers. End users (e.g. property management or administrators for locations requesting an installation) should instead place a request to find a dealer.

***All Dealers are onboarded with Cash Before Shipment (CBS) payment terms for the first six (6) months from their first order with HeadlightSticker™. Terms may be reevaluated after six (6) months upon written request. The Dealer Application may need to be resubmitted.
Payment Type Requested*

Cash before shipment (C.B.S.)***Due On Receipt / C.O.D.Net 10Net 20

Bank Information

The following information is for the purpose of obtaining credit.
Bank Name
Bank Account #
Officer
Bank Phone

Area CodePhone Number
Bank POC Email
example@example.com
Bank Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Active Trade References
Please list references of vendors and/or clients that will validate your business as a member of access control / security / integration industries.
REFERENCE #1
Contact Name
Account #
Ref #1 Phone

Area CodePhone Number
Ref #1 Email
example@example.com
REFERENCE #2
Contact Name
Account #
Ref #2 Phone

Area CodePhone Number
Ref #2 Email
example@example.com
REFERENCE #3
Contact Name
Account #
Ref #3 Phone

Area CodePhone Number
Ref #3 Email
example@example.com

Liability & Officer Guarantee
GUARANTEE: I understand and agree that we are liable for any indebtedness caused by the applicant to HeadlightSticker™, and all costs of collection, attorney's fees, expenses, and interest related thereto.
Owner / Officer Name
Title
Signature*

I accept that the signature below constitutes my electronic signature.
Signature

Clear

Authorization
I hereby authorize HeadlightSticker™ to perform any and all inquiries necessary to validate my application*

YesNo
I attest that all information above is true and will be used for the purposes of validating credit.

YesNo
I hereby acknowledge that I have read, understand, and agree to the dealer terms and conditions set forth above.
Full Name*
Signature*

I accept that the signature below constitutes my electronic signature.
Signature

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Company Information