Sign Up · Wholesale Portal

Applicant Information

First name*

Last name*

Title / Position*

How did you hear about us?*

Email*

Phone*

Include country + city code if outside the U.S.

Billing Address

Address Line 1*

Address Line 2

City*

State / Province*

ZIP / Postal*

Country*

Shipping

Shipping address*

Same as billing Different

Regions product will initially ship to after leaving our facility*

North America APAC Middle East Europe LATAM Caribbean Africa

Future additions require separate approval.

Will product be transferred or re-exported to other regions?*

Yes No

Documents

Attach the following. All files attach to your Zoho Books contact record. Accepted: PDF, JPG, PNG.

W-9 (US) or W-8 (non-US) Required

Resale certificate Required if US-based

EIN certificate / IRS letter Required

Certificate of incorporation / formation docs Required

R2 certificate If R2 = Yes

Government ID for authorized signer Required

Consent and Certification

Terms & Certification

Certification. I, the undersigned, certify — as a duly authorized representative of the Company named herein — that the information provided in this application is true and correct to the best of my knowledge.

Export controls. The Company will not export, divert, re-export or transfer items in any manner inconsistent with the representations above, U.S. export controls, or sanctions laws or regulations, including the Export Administration Regulations ("EAR").

OFAC and sanctions compliance. The Company represents and warrants that neither it, any of its officers, directors, principals, owners, or beneficial owners, nor any party for whom it is acting, is listed on the U.S. Department of the Treasury's Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons List (SDN List) or any other sanctions list maintained by OFAC, the U.S. Department of Commerce, the U.S. Department of State, the United Nations, the European Union, or the United Kingdom. The Company shall not resell, transfer, or divert products to any sanctioned country, region, entity, or individual.

Anti-money laundering. The Company represents that all payments made to Secondlifephones Corporation and Fiducia Corp are from lawful sources and comply with all applicable anti-money laundering laws, including the U.S. Bank Secrecy Act and USA PATRIOT Act. The Company agrees to provide any additional documentation reasonably requested to verify source of funds or ultimate beneficial ownership.

Ongoing accuracy. If any information provided above should change in the future such that this certification is no longer accurate, the Company will promptly correct or supplement the information, or risk immediate suspension or termination from purchasing.

I have read and agree to the terms above. I am a duly authorized representative of the Company.*

Signature*

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Wholesale Application

Applicant Information

Company Information

Billing Address

Shipping

Documents

Consent and Certification