In order to process your request as a Registered Authorized Reseller of Harmony Multimedia Corporation, please complete the following information in the space provided. Please download and complete our Credit Service Application Package. Fill out and sign the completed forms and fax to the Credit Department where your sales representative is located. If you do not have a sales representative assigned, please fax to your nearest office
After reviewing and approving your completed Credit Service Application Package , your registered customer number will be issued within 24 hours. Thank you.

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Name (First, Last):
Company Name:
Title:
Customer Account #:
Address:
Street:
City:
State:
Zip Code:
Telephone:		ex.
Fax Number:
E-Mail Address:
Company Website: