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Application Reseller 101

This document is a reseller application that collects information about a business such as legal name, addresses, business structure, estimated monthly purchases, payment terms, bank and trade references, and personal details of owners/partners. It also includes an individual personal guarantee that must be signed agreeing to pay any obligations of the business.

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75 views3 pages

Application Reseller 101

This document is a reseller application that collects information about a business such as legal name, addresses, business structure, estimated monthly purchases, payment terms, bank and trade references, and personal details of owners/partners. It also includes an individual personal guarantee that must be signed agreeing to pay any obligations of the business.

Uploaded by

osfsdfjoadfosdfjsdfj
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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RESELLER APPLICATION

Legal Business Name Billing Address Shipping Address Business is a : Dun & Bradstreet Address : a: Parent Address City Do you require a purchase order # before we accept an order ? Have you ever filed for bankruptcy? Yes AlP Contact E-mail Address : Estimated Monthly Purchases: $ Terms Requested : (Indicate Preference) COD Company Check COD Post Dated Check Credit Card (Visa, Master Card, American Express only) Net Terms - Credit Line Requested $ No Yes State No If yes, please attach explanation Subsidiary Division (if yes, check which) Company Name : : Zip Corporation LLC Trade Name - DBA City City Partnership # Phone Number: Fax Number: State State Zip Code Zip Code

Proprietorship Federal I.D. # : Web Site Are you

Year Started State of Inc.

BANK AND TRADE REFERENCES MUST BE COMPLETED TO BE CONSIDERED FOR NET TERMS ***PLEASE INCLUDE CURRENT YEAR END FINANCIAL STATEMENTS WITH NET TERMS REQUESTS***
Financial statements must include a balance sheet and income statement. Un-audited financial statements must be signed and dated by the company's ownerlofficer. The statements time period must be indicated.

Check one : Name : Home Address : City Home Phone : Social Security # : Birthdate : E-mail Address: Bank References Name Street Address

Principal

Partner

Proprietor

State

Zip

Contact Name City, State, Zip Code Savings No.

Phone No. Date Opened Loan No.

Type of Account : Checking No.

Trade References (Major Suppliers) 1. Name Street Address 2. Name Street Address 3. Name Street Address Contact Name City, State, Zip Code Contact Name City, State, Zip Code Contact Name City, State, Zip Code Phone No. Account No. Phone No. Account No. Phone No. Account No.

Authorized Individual (Print Name)

Signature

Title

Date

INDIVIDUAL PERSONAL GUARANTEE


I,
(guarantor's name)

, residing at
(home address)

for good and valuable consideration, including the extension of credit which I hereby acknowledge as having been received do hereby personally guarantee and promise to pay any obligation to ASI on demand for any indebtedness of to _____which may become due.
(company name)

This guarantee shall be a continuing and irrevocable guarantee and indemnity to ______. Further, I hereby subrogate any indebtedness of of extension of credit. Date Please attach personal financial statements of guarantor. which it may have to me the indebtedness of _____.

I do hereby waive notice of default, non-payment and notice thereof and to jury trial and consent to all renewals and modifications

Signature

Social Security Number

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