Orion Mobile Dealer Sign Up Packet

Sub-Dealer Candidate Information For Company Pre-Approval
Carrier Sign Up List (Subject to Carrier Approval)
Company Rep
Sub-Dealer Business Name
DBA (If Any)
Sub-Dealer First and Last Name
Sub-Dealer Title
Email
example@example.com
Date of Birth
Social Security Number (Must Enter SSN. Application will not be processed without it)
Federal Tax ID Number
Sales Tax / Certificate of Authority
Business Tax Classification
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Business Address

Street Address

Street Address Line 2

CityState

Zip Code
Business State of Formation
State of Store Location
How many locations do you own?
Type of Business
Years in Business
Work Phone
Mobile/Home Phone
Bank Name i.e (Chase,BOA)
Bank Address
Bank Routing Number
Bank Account Number
Identification (i.e License, Passport, Permit, State ID)

Cancelof
Voided Check

Cancelof
Articles of Incorporation/Formation

Cancelof
Business License/Tax Exemption Certificate

Cancelof
Today's Date

MonthDayYear
Date
Sub-Dealer Signature
Should be Empty:

Sub-Dealer Candidate Information For Company Pre-Approval