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Seawide Marine Distribution 2016

41698 Eastman Drive, Murrieta, CA 92562 Phone: (949) 515-5360 Fax: (951) 600-8530 www.seawide.com I/WE herewith make application to SEAWIDE MARINE DISTRIBUTION (hereinafter “Vendor”) for credit, or an increase or reconfirmation of our existing account. The undersigned gives and grants Vendor permission to verify or re-verify all information stated herein at any time. I/WE hereby agree that all credit granted and/or extended shall be paid timely in accordance with the Vendor’s set terms. PLEASE ANSWER ALL QUESTIONS Company Name ____________________________________________________________ Corporation LLC Partnership Sole Ownership DBA Name ________________________________________________________________ Federal Tax ID_______________ Business Type ________________ Bill to Address _________________________________________________________ City _____________________________ State _____ Zip __________-______ Phone ( )________________________ Fax ( )______________________ Co Email ______________________________________ Use for news/specials Ship to Address _________________________________________ City __________________________ State _____ Zip ________-______ Freight Forwarder Freight Forwarder Name ________________________________ Years in Business # ______ Amt of Credit Desired $_______________ COD Credit Card What markets does your business target? Marine Outdoor Internet Automotive Other _______________________________________________ Do you have a Retail Storefront/Dealership/Boatyard? ___________ Web Address __________________________________________ % sales from site? ______ FINANCIAL INFORMATION Bank ____________________________________ Acct# ________________________ City________________ State _____ Phone ( ) ______________________ Contact __________________________ Bank Credit Line ________________ Secured Yes No Type of Security ___________________________________ Has applicant or any owners, principles, members, officers, or directors ever filed a voluntary petition for bankruptcy, been adjudged bankrupt, or made an assignment for the benefit of creditors? Yes No If yes, please explain ___________________________________________________________________ TRADE REFERENCES (Required) Name ________________________________ State ____ Phone ( ) ________________________ Fax ( ) _______________________ Acct # _____________ Name ________________________________ State ____ Phone ( ) ________________________ Fax ( ) _______________________ Acct # _____________ Name ________________________________ State ____ Phone ( ) ________________________ Fax ( ) _______________________ Acct # _____________ Name ________________________________ State ____ Phone ( ) ________________________ Fax ( ) _______________________ Acct # _____________ PLEASE PROVIDE CONTACTS WITH THEIR TITLES AND CONTACT INFO Co Principal ___________________________________ Title ____________________ Phone ( ) ___________________ Email ____________________________ Sales Contact __________________________________ Title ____________________ Phone ( ) ___________________ Email ____________________________ A/P Contact ___________________________________ Title ____________________ Phone ( ) ___________________ Email ____________________________ Please specify preferred method of invoice delivery Email ________________________________________________ Fax ____________________________ Please specify preferred method of statement delivery Email ______________________________________________ Fax ____________________________ AGREEMENT The undersigned hereby certifies that the information provided on this Dealer Application and Financial Information is true and correct. The undersigned further agrees to be jointly and severally liable for payment of all invoices for products shipped by Seawide, including payment of late fees, finance charges and legal fees which may be owed to Seawide by Dealer. The undersigned represents that the undersigned has read the Dealer Information and Terms in the cover letter signed by Mike Yarbro, the CEO of Seawide, and on behalf of Dealer, agrees to be bound by such terms and conditions contained in the Dealer Information and Terms cover letter. The undersigned represents and warrants that they have the authority to bind the Dealer. Signature _______________________________________________________________________Title ___________________________________________________ Print Name ______________________________________________________________________Date __________________________________________________ (Please SIGN and PRINT name above. NOTE: Signature Must Be Owner, Partner, Officer, or Managing Member if an LLC) For Office Use Only CUST # ______________________________ Date Rcvd _________________ Cust Since ____________________ Terms or Limit Increase Request? Yes No Initial Terms______________________ Terms__________________ Salesperson ___________________ Class ___________________ Territory ________________ Initial Limit_______________ Limit____________ Resale___________ Manager_________________ User ID____________________ Password ________________ CC Customer Salesperson Manager AR Rep Website Avatax 3


Seawide Marine Distribution 2016
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