OtterBox and LifeProof Authorized Reseller Application

Please fill this form out in its entirety. Incomplete applications may not be processed. Applications may take up to 5 business days to process.

COUNTRY



Reference Number (if applicable)
  Format: 1234567ABC
CHANNEL OF BUSINESS

Primary business:

Business Type:  
 
CONTACT INFORMATION
Legal Business Name*
DBA
FEIN/Business Number*
  US Format: ##-#######
CA Format: #########
Contact*  
Phone* Ext.
  Format: (###) ###-####
Email*  
Website  

 

Business Address  
Address Line 1*
  (E.g. 123 S Main St or 10 Symmetry Ave NW )
Address Line 2
  (E.g. Ste 12 or Unit B )
City*
State/Province*
Postal Code*
 
Shipping Address
   
Address Line 1
  (E.g. 5713 Defender Blvd or 17 N Commuter Hwy )
Address Line 2
  (E.g. # 9 or Ste A )
City
State/Province
Postal Code
Number of Retail Locations*
Other Locations  
Please attach a spreadsheet (.xls, .xlsx, or .csv) containing the addresses of additional retail locations that you wish to be authorized.  
Please use the following column headings: Location Name, Address Line 1, Address Line 2, City, State, Zip Code  
BUSINESS PLAN

Organization type:*   Independent   Corporate   Franchise   Subsidiary

If your organization type is Franchise or Subsidiary, please enter the name of your Franchisor or Parent Company:

Are you affiliated with a wireless carrier?
Yes No

With which wireless carriers are you authoirized to sell and activate mobile devices?
     
     
   
   
   

 

Have you sold OtterBox or LifeProof products in the past?
Yes No

Do you sell other mobile cases/accessories?
Yes No

What distributor were you referred by?
Referring distributor sales rep:
Your account number with the referring distributor:
Otter Products Sales Rep:
If you selected a B2B option in the Channel of Business section and would like to specify additional distributor accounts to be included in your application, please select them below and enter your corresponding account number(s).
Secondary B2B Distributor:
Your account number with the Secondary B2B distributor:
Tertiary B2B Distributor:
Your account number with the Tertiary B2B distributor:
RETAIL ENVIRONMENT

RETAIL ENVIRONMENT/BUSINESS MODEL*
If you sell online, please include a list of all of your seller IDs and corresponding marketplaces.

Store Images:

Front of store*

Interior of store*

Dedicated Otter Products space*

**If you selected a B2B option in the Channel of Business section and do not have a physical retail location, please upload three images of your company logo or business card in lieu of store images.

LEGAL AUTHORITY