Template Page

BalmerMantel Logo
TELEPHONE: 1 800 665 3454 or 416 491 6425
HOME
CONTACT
PRODUCTS
MANTELS
OVERMANTELS
SURROUND & HEARTHS
DEALER LOCATION
INSTALLATION
DEALER CENTER
FAQ

NEW ACCOUNT DEALER CREDIT APPLICATION

or Download Form and Fax to: 1.800.461.4445 Attn: Customer Service

Please fill out all the required fields*

COMPANY INFORMATION
*Company Name
Date Established(YYYY-MM-DD)
*Contact name & position
*Telephone
Email
Fax
*Bill To Address
*City
*State/Prov
*Zip/Postal Code
*Country
*Ship To Address **for multiple ship to address, please attach separate sheet
*City
*State/Prov
*Zip/Postal Code
*Country
*P.S.T.Exemption # (Canada)
COPY OF ORIGINAL REQUIRED
*Fed ID# (USA) W9 REQUIRED
Website Address
DUNS#
Type of Business

Principals
Name
Telephone
Extension
President/Owner
Vice President
Accounts Payable

REFERENCES
BANK NAME
ACCOUNT #:
CONTACT NAME
TEL:
FAX:

LIST THREE(3) SUPPLIERS
COMPANY NAME
CONTACT
TELEPHONE
FAX

LIST CURRENT NAMES OF DISTRIBUTORS FROM WHICH MANTELS ARE PURCHASED
COMPANY NAME
CONTACT
TELEPHONE
FAX

The Dealer shall pay the Company on terms 4%-15, net 30 days for all goods ordered by the Dealer.  Dealer shall not be entitled to make any deduction or other offset from payments due the Company unless a credit memo has been issued by the Company.  Titles of the goods remains with the Company until goods are paid for in full.  All overdue accounts accrue interest at the rate of 1 ½% per month (18% APR).  Freight is 10% of order value for orders less than $15,000.00 and freight is free on orders in excess of $15,000.00.  On each order only one delivery location may be selected.  Should more than one location be required then freight is extra regardless of the order value and a handling fee may be charged by the Company to compensate for a multitude of ship to locations.  The Dealer agrees to the warranty terms as specified.  The Dealer is not authorized to make any warranty representations on behalf of the Company or take any remedial action without the expressed written consent of the Company.  Failure to obtain consent may at the option of the Company, result in the Dealer retaining the warranty liability.  The Company shall not be obligated to accept from the Dealer, to make exchanges for or to credit Dealer for any amounts attributable to any products returned by Dealer unless the Company issues a return authorization for said products.  Products returned under Company authorization must be properly packaged and shipped freight prepaid and are subject to a 25% restocking charge.  The Dealer is an independent contractor with no authority to assume or create any obligation, expressed or implied, in the name of the Company, or to bind the Company in any manner.
*NAME (please print)
SIGNATURE
TITLE
*DATE (YYYY-MM-DD)

The signature on this Credit Application, if transmitted by facsimile machine, will be acceptable and binding as if it were the original.

Copyright ©2006, Balmer (R) (1835) Inc. (Architectural Moldings) All rights reserved.
Balmer Moulding, Crown Molding, Wall Moldings + Ceiling Mouldings Home Page
Privacy Policy