Become a Dealer

Please fill out all of the information below to open a new dealer account with Modern Wireless. Your account will be reviewed and you will be contacted within 24-48 hours.

Business Information

First Name

Last Name

Company Name

Phone Number

Mobile Number

Entity Type

Tax ID or SSN

Address

City

State

Zip Code

Dealer Information

What carriers are you interested in?

Simple Mobile

TracFone

What products are you interested in?

GSM Phones

CDMA Phones

Tablets

Accessories

Location Type

Primary Business Type

How many stores do you own?

Number of Monthly Activations

Current TSP

Referred By

Account Setup

Email Address

Sales Rep

Password

Tracfone DAP ID

Seller's Permit

Store Exterior Image

By submitting this form, I certify that the information provided in this form is true and correct, and I authorize Modern Wireless Inc. to open a new account.

Business Information

Dealer Information

Account Setup

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