By clicking [Submit] you hereby authorize Empire Scientific to use all the information you provided to perform the necessary background and credit checks concerning your business. This information will be used soley ito assist the determination of your business' ability to become an approved Empire customer. All information supplied will remain confidential between your company and Empire, and none of this information will be resold or made public by any means. We reserve the right to keep this information in our files for potential future contact with you and/or your business. Misleading or intentionally incorrect information will force us to bar you and your company from ever being an Empire reseller, as we pride ourselves on the high level of professionalism and integrity we expect from ourselves and all those who handle our products. This is only an application for becoming a reseller; there are no guarantees expressed or implied at this time.
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