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Last Name *

Email *

Phone Number *

Company Name *

Website *

Business Type *

Market Segment *

Title *

50% or more of your company owned by a separate entity other than named above? If yes, please list entity name.*

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Main Contact (If different from Account Holder)

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Last Name

Phone Number

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Billing Address 1 *

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Finance Contact Email *

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Shipping Address 2

City *

Postal/Zip Code *

Shipping Contact Name *

Shipping Contact Phone Number *

Ship Method and Account Number

By registering as a user on the Flip Electronics' website and purchasing Product, I hereby certify that I am purchasing on behalf of a business with a valid Sales Tax Certificate Exemption and not for individual/personal consumer use.

I hereby certify the information supplied herein is accurate and complete.

New international customers can expedite the account request process by completing the End User Compliance Agreement.

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