Customer Information
*
*
*
*
*
*
*
*
*
*
?
?
Contact Information
Main Sales Contact
*
*
*
*
Main Service Contact
Financial Information
Main Accounting Contact
*
*
*
*
*
*
*
? *
Market Information
Market
*
*
Verticals
We focus on the following verticals (Select all that apply)  * 
Uploads

Important: For USA applicants, required uploads include your Reseller Certificate and/or Sales and US Tax Exempt form at a minimum. For all Country applicants applying for payment terms, please upload your latest Audited Financials. If this is not available, your most recent Balance Sheet or Income Statement can be provided.

Drag & Drop Files Here
File Type Option

No files uploaded.

Application Submission
Application Agreement * 
  By agreeing to this reseller application form, you are confirming that you have approval authorization at your company and will be bound by the Lifeboat Distribution’s Reseller Terms & Conditions, which are available at: Lifeboat Distribution Terms & Conditions. In addition, permission is granted to Lifeboat Distribution, to obtain credit information from all listed trade and bank references. I understand that the credit terms are net 30 days from date of invoice unless otherwise stated, and that the account may be subject to a finance charge on past-due balances of 1.5 % per month (18% per annum). I understand that orders may not be shipped if the account is past due. I certify that all information contained in this credit application is correct in all respects. I also certify that I am an authorized signing official of the Company named above.
*
*

Subscription Preference (Select all that apply) *
Lifeboat Distribution
Please Wait...
; ;