Authorized Dealer Application
Company Name _______________________________________
Authorized Buyer(s) _______________________________________
Phone _______________ Fax ________________ Buyer Email ____________________
Billing Address __________________________________________________________________
Shipping Address ________________________________________________________________
Web Address _________________________ Is it a commerce site? _____________________
Accounts Payable Contact(s) ______________________ Email Invoices/Statements?__________________
A/P Phone_______________________ A/P Fax ___________________ A/P Email___________________
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Terms Desired: ◊ Net 30 ◊ COD(UPS) ◊ Credit Card ◊ Desired Credit: $
If paying by Credit Card: CC# ____________________________ Exp. Date____________________
Card Holder Name ____________________________________ Signature __________________________
Card Billing Address _________________________________________________________________________
**Please Note: Your initial order(s) will be processed on credit card or COD until terms are established**
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Line of Business _________________________________________ Year of Establishment _________________
Federal tax ID#_______________ ◊ Corporation ◊ Partnership ◊ Individual Years of Ownership______
Please attach a copy of your valid Reseller Permit:# ______________________ State_______________
Owner/Officer Names ______________________ Title _________________________________________
______________________ Title _________________________________________
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Trade References(business name, phone & fax #’s, reference/account number) PLEASE PRINT CLEARLY
1) _________________________________________________________________________________________
2) _________________________________________________________________________________________
3) _________________________________________________________________________________________
4) _________________________________________________________________________________________
Bank References (institution name, full address, phone number, account type, account number)
1( ________________________________________________________________________________________
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I certify that the information contained herein is correct and I authorize you to obtain such information as you may require concerning the statements made in this application, and agree that the application, including the information furnished by me, is true and complete and is made for the purpose of obtaining credit. I further agree to submit such additional information concerning my financial status as requested. I also understand that there is a 1.5% late charge per month on past due accounts. It is understood and agreed to that the undersigned will continue to be liable in the event of the sale of the business. I have read and agree to the terms of their application.
Officer or Principal name Signature Date
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Terms of Account: Net 30 from date of Invoice. If approved applicant agrees to pay upon demand at any time to Sniders Elevator Inc, the full amount of said indebtedness, including finance charges of 2% per month (24% annual).
The undersigned herby certifies that the above is true and complete to the best of his/her/their knowledge, and that any credit granted will be used for the purpose of agricultural products of services. Information provided or authorized to be disclosed to Sniders Elevator Inc, will be used solely for the purpose of establishing and monitoring credit and collecting credit extended to you.
The undersigned herby authorizes any banks, lenders, other grantors of credit or credit agencies to provide Sniders Elevator Inc copies of applicant’s financial statements and all other information regarding the character, reputation, financial responsibility and indebtedness of the undersigned and herby releases Sniders Elevator Inc and any banks, lender or other grantors of credit from any and all claims or causes of action that may arise or which he might have by reason of information furnished Sniders Eleavator Inc by said bank, lender or other grantor of credit.
Customer authorizes Sniders Elevator Inc to execute from UCC-1 and/or any other documents necessary to give public notice of Sniders Elevator’s security interest in Customer’s inventory, products, accounts receivables, or other items used as secured collateral for Customer’s extension of credit. Customer hereby grants Sniders Elevator a purchase money security interest in all agricultural products or services received or obtained through this extension of credit.
The undersigned hereby certifies and agrees that APPLICABLE CREDIT TERMS will be stated by invoicing or will be determined by current and future signed Addendum(s) to this Application For Credit. In each event credit is approved and charge sales are made, the undersigned hereby agrees to pay a finance charge on the past due balances calculated monthly at the maximum rate permitted by law in the state of the applicant’s business location for this type of contract, or at the rate established from time to time by Sniders Elevator Inc and advised to the undersigned, whichever is lower; and further agrees to pay reasonable legal fees and other reasonable costs incurred for the collection of overdue amounts; and further agrees that the venue for any action brought for collection on undersigned’s account shall be in any State or Federal Court at Sniders Elevator’s sole discretion and election and the undersigned waives the right to challenge the placement of venue in such an action; and the parties herein agree to waive any right to a trial by jury of any action brought for collection of the undersigned’s account with Sniders Elevator Inc.
GUARANTEE: Notwithstanding the fact that this application may be executed in a corporate or reprehensive capacity, each of the undersigned, for consideration of credit extended, do hereby applicant/customer herein. This guarantee shall not be affected by the amount of credit extended. The undersigned waives notice of any change in credit terms, changes in extensions of credit. This guarantee may only be revoked in writing to Sniders Elevator and only applies to those purchases made by applicant/customer after said writing is received by Sniders Elevator Inc.
Signature :__________________________________
Title: ______________________________________
Date: ______________________________________