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Xentris LogoXentris Wireless- Indirect Dealer Agent Registration
   Registration Form

Your Contact Information

Company Information [BILL TO] 

IMPORTANT

Ship-To (You can add 1 Ship-To address during the registration process.  Others can be added once you log-in)

Tell Us about Your Business

What Brought You to Xentris Today

Company Officers:

Your Company is: *



Terms & Agreements

IMPORTANT

BY TYPING YOUR FULL NAME IN THE SPACE PROVIDED, AND CHECKING THE BOXES ABOVE YOU ARE INDICATING THAT YOU AGREE WITH THE TERMS AND CONDITIONS OF BEING AN INDIRECT DEALER, THE XENTRIS WIRELESS MAP AGREEMENT AND YOU ARE PURCHASING PRODUCTS FOR THE PURPOSE OF RESALE. THE CHECKBOXES AND YOUR NAME BELOW ACT AS YOUR SIGNATURE FOR THE INDICATED TERMS AND AGREEMENTS.



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