Thank you for your interest in becoming an iWallet Authorized Dealer. The iWallet Authorized Dealer Program is the exclusive means by which to earn the right to carry the iWallet in your store. Please complete and submit the form below. A representative will follow up as soon as possible.

BASIC CONTACT INFORMATION:

Company Name (required)

First Name (required)

Last Name (required)

Address Line 1 (required)

Address Line 2 (optional)

City (required)

State/Province (USA-Canada) (required)

Zip/Postal Code (required)

Country (required)

Phone 1 (required)

Email Address (required)

ADDITIONAL INFORMATION

Would you like to be an Exclusive Distributor?

Would you like to be part owner of iWallet Corporation?

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