VLR Communications

Dealer Registration

Please fill out the following registration form if you would like access to the dealer pricing information available on our website. Once you have successfully registered for an account, your account will go through an approval process. Once your account has been approved, you will be able to log in with your e-mail address and a password to view the dealer pricing for each product.

Please download and fill out our W-9 Tax ID Form for your records.

If you have any questions, please contact us.

Bold fields are required.

Contact Information
Company Name
First Name
Last Name
E-mail
Choose a Password
Confirm Password
Address
Address
Address (line 2)
City
State	(ex: IL)
Zip	(ex: 11111)
Country
Phone
Fax
Additional Contact Information
Contact 2
Contact 2 Phone
Contact 3
Contact 3 Phone
Financial Information
State Retail Tax ID	(If in Illinois)
Federal ID
Would you be making purchases with a credit card?	yes no
Bank Name
Bank Address
Bank Address (line 2)
Bank City
Bank State	(ex: IL)
Bank Phone
Other Information
Web Address
Years in Business
Type of Business	(corp., proprietership, etc.)
Product Lines Handled
Please list at least 3 professional references here


Equipment Cost:	Email:

In Partnership with
Crest Capital Equipment Leasing Company