Become a Product Reseller

Fill out the application information below to begin the process of becoming an American Safety Council affiliate. Please make sure to include as much relevant information as possible.

Company name *

Company Website *

Company Type *

Company Employer Identification Number (EIN)? *

Years in business? *

First Name *

Last Name *

Email Address *

Title *

Business Address

City

State

Zip Code

Work Phone

Cell Phone

What courses are you interested in selling? Please include the name of the course and the states, if applicable.

Do you currently maintain any other affiliate or reseller relationships? *

Yes No

If yes, please describe these products or services you offer as an affiliate or reseller.

How do you envision reselling our product and how would the course offerings be marketed? *

Do you have an anticipated or estimated volume of courses you may need to purchase per year? *

Do you already have clients interested in these products, or is this just an anticipated potential future need? *

I certify that the information provided is true, accurate and complete and that any incorrect information or omission will result in immediate disqualification or termination. *

I Agree

If you need additional information regarding our reseller program, email us at: reseller@amersc.com