FIND A DEALER


BECOME A DEALER


CONTACT INFORMATION
Mailing Address:
ZIGEN
6934 Canby Ave. Suite 107
Reseda, CA 91335

Toll Free:
877 650-5252

Local Phone:
818-654-5252

Fax:
818-654-5355

Email:
info@zigencorp.com
Become A Dealer

 

Want to become an Authorized ZIGEN Reseller? Complete the form below and a representative will contact you shortly

ZIGEN exclusively sells through a carefully selected network of Authorized Resellers. Unfortunately, some of our products have been found on various websites that are Not Authorized to sell ZIGEN Products. In order to maintain the high level of product service and support that ZIGEN is known for, the ZIGEN PRODUCT WARRANTY only covers products that have been purchased through an Authorized Reseller.
Company Name  
Parent Company  
Resale License Number

A value is required.
Terms Applied for:
Type of Business A value is required. Affiliations
PHYSICAL ADDRESS:
Street A value is required. City A value is required.
State A value is required. Zip A value is required.
Phone A value is required. Fax A value is required.
Website A value is required.
BILLING ADDRESS (If different from physical address)
Street City
State Zip
Phone Fax
Email


SHIPPING ADDRESS (If different from physical address)
Street City
State Zip
Phone Fax
Email
OFFICER 1
Name A value is required. Title A value is required.
Home Address
Street A value is required. City A value is required.
State A value is required. Zip A value is required.
Phone A value is required. Fax A value is required.
Email A value is required.
OFFICER 2
Name Title
Home Address
Street City
State Zip
Phone Fax
Email
PURCHASING - All marketing materials will be sent to this person.
Name Phone
Email
RECEIVING - Shipping confirmation will be sent to this person
Name Phone
Email
Accounting - Billing correspondence will be sent to this person
Name Phone
Email
REFERENCES
Vendor 1
Contact Account Number
Street City
State Zip Code
Phone Fax
Email COD?
Vendor 2
Contact Account Number
Street City
State Zip Code
Phone Fax
Email COD?
Vendor 3
Contact Account Number
Street City
State Zip Code
Phone Fax
Email COD?
Vendor 4
Contact Account Number
Street City
State Zip Code
Phone Fax
Email COD?
By submitting this form you are granting ZIGEN the right to obtain credit information from all listed references. All accounts are responsible for a late charge of 1.5% per month (18% annum) on all past due invoices. All orders will be withheld if an account is past due and any collection fees (including attorney fees) and related costs will be the responsibility of the account holder. By submitting this form account holder assumes all personal and individual responsibility and liability, and gaurantees payment of all charges due and payable to ZIGEN.






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