Dealer Application

Organization Information
Full Legal Name
Please type your full name.

DBA or Tade Names
Please type your DBA or tade names.

Are you COPS Monitoring Dealer?
Please check an option.

Monitoring Center
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COPS Representative
Please type your COPS representative.

COPS Dealer Number
Please type your COPS dealer number.

Physical Business Address
Please type your business address.

Physical City
Please type your City.

Physical State
Please select your State.

Physical Zip
Please type your zip code.

Do you have a different mailing address?
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Mailing Address
Please type your mailing address.

Mailing City
Please type your City.

Mailing State
Please select your State.

Mailing Zip
Please type your zip code.

Years in Business (Company)
Please type the years in business.

Federal Tax I.D. Number
Please type the federal tax I.D. number.

State Lic #
Please type the your state lic. number.

Lic. Exp. Date
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Office Phone
Please type your phone number.

OfficeFax
Please type your fax number.

Primary Email
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Company Website
Please type your company website.

Number of Offices
Please type the number of offices.

MarketLocations
Please type the market locations.

Type of Entity (Select One)
Please select one.

Owners/Managers
Name
Please type the name.

Title
Please type the title.

Phone Number
Please type the phone number.

Name
Please type the name.

Title
Please type the title.

Phone Number
Please type the phone number.

Name
Please type the name.

Title
Please type the title.

Phone Number
Please type the phone number.

Equipment Used
Equipment Mfg
Please type the equipment mfg.

Monthly Installs
Please type the monthly Installs.

Equipment Mfg
Please type the equipment mfg.

What Benefits Are You Interested In?
Monthly Installs
Please type the monthly Installs.

Product Savings

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Marketing Support

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Various

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Other

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Security Code
Security Code  Invalid Input

WELCOME!

We look forward to providing you with security product savings, marketing materials and support, and the many more products and services we plan to offer in the near future. By submitting this application, you confirm that you are a professional security company operating in full compliance with federal and state legislation. By signing this application you agree that you have obtained and will maintain all necessary licenses, certifications, and insurance required to install and service burglary and/or re alarm systems in any and all states in which you conduct such installations or service.

PRIVACY POLICY

We protect your privacy while you visit us online. You do not have to provide any personal information to visit this web site. If you provide us information about yourself via e-mail or a web form, your information will be used only for the purposes described at the point of collection, such as to send information or products to you, or to respond to your questions or comments.

Information

Call Jake Voll
866.364.0030 x.222

Address:
635 Progress Way, Sanford FL 32771
Phone: 866.364.0030
Fax: 407.608.1179
Email:info@ssandsi.com