Odyssey - Become a Distributor

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Please complete the following and submit for review and verification of account qualification. If your account is accepted, you will be notified via email containing your username and temporary password within two (2) business days. Please note that incorrect or incomplete information will delay review.

If you are already a distributor, please complete and submit this form so we have your complete and current information and you will receive your username and temporary password within two (2) business days. Thank you for your business!

Company Info:

Company Name ASI#
Website Address
Are you a current distributor of Odyssey FL? Yes No
Mailing Address 1
Mailing Address 2
City State Zip
Phone Fax

Primary Contact Info:

First Name Last Name
Title
Email Phone

Accounts Payable/Billing Info:

Same as Mailing Address Above, or:

First Name Last Name
Email
Billing Address 1
Billing Address 2
City State Zip

Business Type (Please check one):

Individual Proprietorship
Partnership
Corporation
LLC

In what year was this business established?

Federal Tax ID or Social Security #

In what state are you licensed as a Dealer/Reseller?
State Resale Certificate #

Please provide three (3) Supplier references below (at least two (2) must be Ad Specialty Suppliers who you have ordered from within the last year):

Supplier 1 Name
Supplier 1 Phone Fax

Supplier 2 Name
Phone Fax

Supplier 3 Name
Phone Fax

Check here to receive specials and information from Odyssey FL via email.
What email would you like these sent to?

Check here to receive specials and information from Odyssey FL via fax.
What fax # would you like these sent to?