M2 - Supercircuits - Dealer Application Form

Apply for a Dealer Partner Account
We offer a Dealer Partner Program designed to help licensed security dealers and integrators grow by providing qualified dealers exclusive benefits and programs. To learn more about the Dealer Partners program click here.

Every application is reviewed by our sales team to ensure applicants meet dealer program criteria. Your information is completely confidential and our team will reach out with any questions regarding your application.

Please note: all fields with an asterisk (*) are required
Company Name*
Your Name*

First NameLast Name
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Main Phone Number
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Choose your title? (select one)*

Company Information

Tell us more about your business...
Company Website*
Please enter in this format: example.com (if you do not have an official company website enter N/A)
Company Facebook Page*
(if you do not have an official company FB page enter N/A)
Company Address*

Primary Street Address

Street Address Line 2 (Suite #, Building/Unit #, Department, etc.)

CityState / Province

Postal / Zip Code
State Reseller or Exemption Certification (Please upload)

This form is required if you don't want to get charged sales tax because you are reselling product to end-users.
Cancelof
Tax Exempt?*

YesNo
Are you a HUB/MO/WO Business? (select all that apply)*

Minority-Owned BusinessWoman-Owned BusinessService-Disabled Veteran BusinessNot Applicable

Apply for a Dealer Partner Account