Dealers Application Form
Buyer Identification
"Buyer" includes all subsidiaries, division and affiliates
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History
Have you done business under any other name in the past 5 years?
With us?
Have you or any company with which you were associated in the past 5 years been subject to any bankruptcy or insolvency proceeding?
Are there any judgments or legal proceedings pending or threatened respecting Buyer or any Guarantor?
Company Principals-Owners
(All must be set forth below)
1.
2.
3.
Bank References
1.
2.
Trade References
1.
2.
3.
Initial Project
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ALL SUBSEQUENT PROJECTS MUST BE SIMILARLY DESCRIBED FOR GOODS TO BE SHIPPED
Purchase Order Required
This will not limit liability for greater amounts.
CREDIT INFORMATION:
Buyer and Guarantor(s) authorize (1) Seller to contact or to have others contact references and to obtain credit reports and make other credit inquiries about Buyer and Guarantor(s) now and in the future to update information so long as Buyer's obligations are outstanding and (2) such other sources chosen by Seller to provide similar information.
CREDIT CARD AUTHORIZATION:
Buyer and the undersigned hereby authorizes Seller to charge purchase of Buyer to the following credit card account:
BUYER AGREES TO ALL OF THE TERMS AND CONDITIONS OF THIS DOCUMENT INCLUDING THOSE THAT FOLLOW THIS SIGNATURE ON THE NEXT PAGE

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