Account Application Form with BEA, inc.

Billing Address

Street *

This field can not be empty !

City *

This field can not be empty !

State/province *

This field can not be empty !

Postal code *

This field can not be empty !

Shipping Address

Please select the option below if your shipping address is the same as the previous billing address. If not, proceed to the next question. *

Same as billing

Use another address

This field can not be empty !

Street *

This field can not be empty !

City *

This field can not be empty !

State/province *

This field can not be empty !

Postal code *

This field can not be empty !

Primary Contact

Name *

This field can not be empty !

Phone Number *

This field can not be empty !

Email Address *

This field can not be empty !

Services

Security and access control *

This field can not be empty !

Low Energy Doors

High Performance Doors

Commercial Doors

Full automatic pedestrian doors

Gates

How many technicians are AAADM certified ? *

This field can not be empty !

What manufacturer of door and/or gate brands do you represent ? *

This field can not be empty !

Who are your currently purchasing sensors from ? *

This field can not be empty !

Accounts Payable Contact

Name *

This field can not be empty !

Phone Number *

This field can not be empty !

Email Address *

This field can not be empty !

Purchasing Contact

Name *

This field can not be empty !

Phone Number *

This field can not be empty !

Email Address *

This field can not be empty !

Sales Team Contact(s)

Name *

This field can not be empty !

Phone Number *

This field can not be empty !

Email Address *

This field can not be empty !

Add another contact ( 9 Available )

Technician Contact(s)

Name *

This field can not be empty !

Phone Number *

This field can not be empty !

Email Address *

This field can not be empty !

Add another contact ( 9 Available )

Purchase Detail

Auto-invoicing E-mail *

This field can not be empty !

Annual purchase volume of BEA products *

$2,500 to $5,000

$5,000 to $10,000

$10,000+

This field can not be empty !

Are you interested in applying for credit terms ? *

An email will be sent to your "Primary Contact" to finalize the process

Yes

This field can not be empty !

If you have an open account with UPS or FEDEX and would like to use it during ordering, please provide your account number below.

NOTE: Please type your name in the field below acknowledging that you have read and understand the disclaimer below and will send a copy of your resale certificate to your BEA sales representative. *

BEA, Inc. complies with , and requires all parties conducting business with BEA, Inc. to comply with all applicable export, import and trade regulations as outlined by the government of the United States of America and the European Union. Please see the Export Control Compliance section of our Web site for complete information.

This field can not be empty !

Resale Certificate

Please select your State / Territory to determine the need for a Resale Certificate *

This field can not be empty !

I am in a Canadian Province but create nexus (in any of its forms) in US States/territories that are not Alaska, Delaware, New Hampshire, or Puerto Rico.

Resale certificate (PDF only) *

This field can not be empty !

Account Application Form with BEA, Inc.

Company Information

Billing Address

Shipping Address

Primary Contact

Services

Accounts Payable Contact

Purchasing Contact

Sales Team Contact(s)

Technician Contact(s)

Purchase Detail

Resale Certificate

Follow us on

See all our segments

Account Application Form with BEA, Inc.

Company Information

Billing Address

Shipping Address

Primary Contact

Services

Accounts Payable Contact

Purchasing Contact

Sales Team Contact(s)

Technician Contact(s)

Purchase Detail

Resale Certificate

Follow us on

Subscribe to our newsletter

See all our segments