*Application is in PDF format and Adobe Reader is required.

In order to make wholesale purchases from Reagan Wireless Corporation it is necessary to complete a new customer application and fax it back to us. Please download and complete the application above (*PDF FORMAT), sign it, then fax it to 954-596-0070.

Please make sure you have filled in all the required information and sign the document so as not to delay the process. Typically, it may take 2-3 business days to process the average application.

For assistance and questions with the application process please call (954) 596-2355.

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