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General Info

Name:

Billing Address:

Address Line 2:

City:

State:
Zip:

Phone:

E-Mail:

�: �

Shipping Address:

Address Line 2:

City:

State:
Zip:

Fax:

Website:

Federal Tax ID:

Estimated Monthly Credit:

Quarterly Projected Sales:

World EyeCAM Sales Contact:

Sales Contact:
Purchasing Contact:

Business Type: Corporate Reseller
Distributor-NetworkPc
Distributor Security

IT Network Contractor
Security Contractor

Names and Titles of Officers/Owners/Partners:

1.
Title:

2.
Title:

3.
Title:

Bank Reference:

Bank:
Account #:

Address:

Contact:
Phone:

Trade References

1.

Name:
Account #:

Address:

Contact:
Phone:

Fax:

2.

Name:
Account #:

Address:

Contact:
Phone:

Fax:

3.

Name:
Account #:

Address:

Contact:
Phone:

Fax:

World EyeCAM Terms and Conditions

As a dealer there will be no refunds on complete systems or DVR cards, unless otherwise defective.
As a dealer you are responsible for the evaluation of the DVR product BEFORE installation, service, or sale to
your customer/client.
If you inspect that your DVR product is, or has become defective, you may return it for a prompt exchange.
However, you must call technical support for an RMA # before doing so.
If you return a DVR card back to World EyeCAM, and it is not defective there will be a $25.00 diagnostic fee.
Cameras, lenses, power supplies, etc. will come with the standard manufacturers warranty and may be
exchanged and/or returned.
All items returned will have a 15% restocking fee.
World EyeCAM does not handle third party customer support issues, we only deal directly with the dealer
that purchased the item(s).
10 items minimum purchase required.

By checking the box below, I attest that the information on this application is accurate and I agree to World EyeCAM's Terms and Conditions.

Application Date:
Name:

Credit Card Authorization Agreement

I, , from the Company , WorldEyeCAM Customer ID , hereby authorize WorldEyeCAM to put through a charge(s) to my Credit Card. The credit card information is listed as follows:

Card Holder:

Card Account #:
Exp. Date:

Credit Card Issuing Bank:

Card's Bank Phone #:

CVV #:

Credit Card Billing Address:

Address Line 2:

Phone:

Order Shipping Address:

Address Line 2:

Phone:

Please note World EyeCAM reserves the right to deny shipping of order(s) to any address other than the billing address of the credit card if we are unable to verify this address.

By clicking the checkbox below I hereby authorize World EyeCAM to charge this card for all orders placed from my company. Make this my Credit Card on File.

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