Wholesaler Distributor Account Form

Fill out the form below to request having your UEi account linked to the web site for service billing purpose.

FIrst Name:*

Last Name:*

Company:*

Branch (# or identity):*

Branch Address:*

Email Address:* (View Privacy Policy)

Phone:*

UEi Account # (Found at the top of your UEi invoice):

We will contact you with login credentials or if any questions arise in linking your account.

Thank You.

Submit

Wholesaler/Distributor Account Setup