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COMPANY
NAME:
DATE: |
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D.B.A.:
ACCOUNT EXECUTIVE:
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BILLING
ADDRESS:
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CITY:
STATE:
ZIP: |
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TELEPHONE
#:
FAX #: |
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SHIPPING
ADDRESS: |
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CITY:
STATE:
ZIP: |
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FORM
OF OWNERSHIP: |
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FEDERAL
ID. NUMBER:
DATE ESTABLISHED: |
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TYPE
OF BUSINESS:
O MFG
O DISTRIBUTOR
O RESELLER
O VAR |
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DATE
OF INCORPORATION:
MONTH:
YEAR:
STATE INCORPORATED: |
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ANNUAL
SALES:
NUMBER
OF EMPLOYEES: |
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TYPE
OF CREDIT YOU’RE REQUESTING:
SIZE: $ |
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DUNS
#: |
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OFFICER
INFORMATION |
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PRESIDENT/CEO:
TELEPHONE #: (
) |
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SOCIAL
SECURITY NUMBER:
DRIVER’S LICENSE NUMBER: |
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TREASURER:
TELEPHONE NUMBER: (
) |
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SOCIAL
SECURITY NUMBER:
DRIVER’S
LICENSE NUMBER: |
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ACCOUNTS
PAYABLE:
TELEPHONE NUMBER: (
) |
BANK REFERENCES
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NAME: NAME: |
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ADDRESS: ADDRESS: |
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CITY: STATE: ZIP: CITY: STATE: ZIP: |
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TELEPHONE #: TELEPHONE #: |
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CONTACT: CONTACT: |
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ACCOUNT #: ACCOUNT#: |
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ACCOUNT TYPE: O CHECKING O SAVINGS ACCOUNT TYPE: O CHECKING O SAVINGS |
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O OTHER O OTHER |
TRADE REFERENCES |
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1.
NAME:
2.
NAME: |
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ADDRESS:
ADDRESS: |
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CITY:
STATE: ZIP:
CITY:
STATE:
ZIP: |
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TELEPHONE
#:
TELEPHONE #: |
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CONTACT:
CONTACT: |
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ACCOUNT
#:
ACCOUNT #: |
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3.
NAME:
NAME: |
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ADDRESS:
ADDRESS: |
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CITY:
CITY: |
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TELEPHONE
#:
TELEPHONE
#: |
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CONTACT:
CONTACT: |
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ACCOUNT
#:
ACCOUNT #: |
In
order to permit Odyssey Electronics, Inc. to consider credit terms of sale for
purchases made by the undersigned or its agents, herewith applied for, the
undersigned acknowledges that each month, or portion thereof, that the same
remains unpaid, commencing from and after the
date thereof, should Odyssey Electronics, Inc. incur attorney’s fees with or
without the institution of the court or arbitration proceedings in connection
with the collection of any account due by the undersigned, the undersigned
agrees to pay reasonable attorney’s fees and all court arbitration costs in
connection with such proceedings. Buyer
also agrees to pay $20 for each check issued by Odyssey Electronics, Inc. which
is returned without payment. In signing this document, Buyer grants permission of credit
information to be submitted by the phone or letter by companies the buyer has
specified. The undersigned
understands Odyssey Electronics, Inc. will keep this application as a continuing
statement of the undersigned’s financial condition until notified otherwise.
The information and statements in the application are true and complete,
and are made for the purpose of inducing you to establish a line of credit.
Print
Name___________________________________________Title______________________
Phone: (949) 249-3560 Fax: (949) 249-6675
To Our Customers:
In compliance with
Sales and Use Tax Laws, It is
necessary that we have from all our customers a signed re-sale certificate, with
their State Sales Tax Permit Number, to show that the merchandise has been
purchased for re-sale.
The good faith of the
seller will be questioned if he has knowledge of facts which give rise to a
reasonable inference that the purchaser does not intend to resell the property
as, for example, knowledge that a purchaser of particular merchandise is not
engaged in the business of selling that kind of merchandise.
Under “Description
of property to be purchased” there may appear:
(1)
Either an itemized list of the particular property to be purchased for
resale, or
(2)
A general description of the
kind of property to be purchased for resale. Such certificate is good until
revoked in writing.
FIRM NAME__________________________________________________________________________
I HEREBY CERTIFY,
That I hold valid
seller’s permit NO.__________________________________________
Issued pursuant to
the Sales and Use Tax Law; that I am engaged in the business of selling
__________________________________________________________________
that the tangible
personal property described herein which I shall purchase from:
will be resold by me
in the form of tangible personal property; PROVIDED, however, that in the event
any of such property is used for any purpose other than retention,
demonstration, or display while holding it for sale in the regular course of
business, it is understood that I am required by the Sales and Use Tax Law to
report and pay for the tax, measured by the purchase price of such property.
Description of
property to be purchased: _____________________________________________________
Dated
_______20____________ Signature
__________________________________________________
At
_______________________ By
and Title_________________________________________________
Phone_____________________
Address____________________________________________________
Phone: (949) 589-4797