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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*
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*Company Name |
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Date Established(YYYY-MM-DD) |
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*Contact name & position |
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*Telephone |
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Email |
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Fax |
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*Bill To Address |
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*City |
*State/Prov |
*Zip/Postal Code |
*Country |
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*Ship To Address **for multiple ship to address, please attach separate sheet |
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*City |
*State/Prov |
*Zip/Postal Code |
*Country |
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*P.S.T.Exemption # (Canada)
COPY OF ORIGINAL REQUIRED |
*Fed ID# (USA) W9 REQUIRED |
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Website Address |
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DUNS# |
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Type of Business |
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Name |
Telephone |
Extension |
President/Owner |
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Vice President |
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Accounts Payable |
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REFERENCES |
BANK NAME |
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ACCOUNT #: |
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CONTACT NAME |
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TEL: |
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LIST THREE(3) SUPPLIERS
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COMPANY NAME |
CONTACT |
TELEPHONE |
FAX |
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LIST CURRENT NAMES OF DISTRIBUTORS FROM WHICH MANTELS ARE PURCHASED |
COMPANY NAME |
CONTACT | TELEPHONE |
FAX |
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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.
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*NAME (please print) |
SIGNATURE | TITLE |
*DATE (YYYY-MM-DD) |
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The signature on this Credit Application, if transmitted by facsimile machine, will be acceptable and binding as if it were the original.
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