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reseller

VIEWS: 3 PAGES: 2

  • pg 1
									                                            RESELLER                         Eagletron Inc.
                                                                             6 Hoskin Ave.
                                           APPLICATION                       Toronto, ON M5S 1H8
                                                                             Canada
                                                                             tel: 416-323-2233
                                                                             fax: 416-598-5354
RESELLER INFORMATION
Business Name________________________________Corporation Name______________________________
Address___________________________________________________________________________________
City____________________ State ______ Zip______________Country_______________________________
Business Phone Numbers ( )______________ ( )_________________ Fax # ( )___________________
E-mail address_______________________________ Purchasing Manager______________________________
Ship to (If different from above):
Name_____________________________________________________________________________________
Address___________________________________________________________________________________
City____________________ State _______ Zip_____________ Country_______________________________
BANK AUTHORIZATION FOR CREDIT
Bank Name____________________________________________ Branch______________________________
Address_______________________________________________ Phone ( )__________________________
City____________________ State ______ Zip______________ Country_______________________________
Account Numbers (Business Only) Checking_________________________ Savings______________________
Business Loan Account Numbers_________________________________ Contact at Bank________________
OWNERS INFORMATION                                           BUSINESS REFERENCES
Your business is _____Solely Owned _____A Partnership            Name__________________________________
____A Corporation - Please list names of all Owners (Principals) Address________________________________
   Name________________________________________                  City__________________ State ___ Zip______
   Address_______________________________________ Phone # ( )_____________ Fax___________
   City_______________________ State ___ Zip________ Account Number_________________________
   Social Security No.______________________________ Buying: COD/Cash COD/Check CIA Open
   Phone # ( )____________________                               Credit Limit_____________________________
   Name_________________________________________ ________________________________________
   Address_______________________________________ Name_________________________________
   City ______________________ State___ Zip_________ Address________________________________
   Social Security No.______________________________ City___________________ State ___ Zip_____
   Phone # ( )____________________                               Phone #( )_______________ Fax__________
ACCOUNT STATUS                                                   Account Number_________________________
(You would like your account to be:)                             Buying: COD/Cash COD/Check CIA Open
___ COD/Cash Only ___COD/Check Acceptable                        Credit Limit_____________________________
___ Cash in Advance ___Company Credit Card                      ________________________________________
___ Credit Request with available credit $__________              Name__________________________________
                                                                  Address________________________________
BUSINESS DEMOGRAPHICS                                             City___________________ State ___ Zip_____
                                                                  Phone # ( )______________ Fax__________
Years in Business _______ Manufacturer of ____________ Account Number_________________________
                              _________________________ Buying: COD/Cash COD/Check CIA Open
                              _________________________ Credit Limit_____________________________
Number of Locations_____ _________________________
                              _________________________
                              _________________________
Annual Volume__________ Distributor of ______________        PLEASE RETURN TO:
Business Hours__________ _________________________           JOHN LAU
______________________ _________________________             FAX (416-598-5354)
Internet Site_______________________________________
                                                         -PAGE 2-
         I understand and acknowledge that placing an order with Eagletron Inc. constitutes doing business in Ontario and
is therefore subject to the laws of the Province of Ontario.
         Should credit availability be granted by Eagletron Inc., all decisions with respect to the extension or continuation
shall be at the sole discretion of Eagletron Inc.. I understand that I may terminate any credit availability at my discretion at
any time.
         I agree to pay the Net Total before cash discount on my invoices in full within 30 days of invoice date. (Payment
within 10 days allows me to take advantage of all cash discounts.) I acknowledge that if payment is not made within 30
days, a FINANCE CHARGE will be added to my account. All payments I make will be first used to pay any unpaid
FINANCE CHARGE and then to pay the earliest charges on the account. Any FINANCE CHARGE added will be
determined by applying a 1.5% periodic rate (18.0% ANNUAL PERCENTAGE RATE) to the average daily balance. I
further understand that I may prepay the account at any time without penalty. I understand and acknowledge that it is my
responsibility to give written notification to Eagletron Inc. prior to any change in ownership and an intended date to cease
operation. I also understand that any account established based on the information furnished here is for my exclusive use
and is not transferable.
         In the event this account becomes delinquent and is turned over to any collection agency or attorney for collection,
I agree to pay collection fees and/or attorney fees not exceeding 30% plus court costs, serving costs and/or any other
miscellaneous expenses incurred as a result of my failure to pay.
         I authorize Eagletron Inc. to make whatever credit inquiries that it deems necessary in connection with this credit
application or in the course of review or collection of any credit extended in reliance to this application. I authorize and
instruct any person or credit reporting agency to compile and furnish to Eagletron Inc. any information that it may have or
obtain in response to such credit inquiries and agree that such information, along with this application, shall remain the
property of Eagletron Inc. whether or not credit is extended.

Signature_____________________________________________________                        Date____________________
Position______________________________________________________
Signature_____________________________________________________                        Date____________________
Position______________________________________________________
Corporations or LLC only:                                                I hereby personally guarantee any indebtedness
                                                                         to Eagletron Inc. incurred by:

                 (Corporate Seal)                                        _______________________________________
                                                                             Corporation Name
                                                                         _______________________________________
                                                                             Individual Guarantor/Owner
                                                                         _______________________________________
                                                                             Individual Guarantor/Owner
A Corporate or LLC application must be signed by the owners as personal guarantors of all purchases made by the
corporation/llc in order to receive a positive review.

        Note: Application cannot be processed without signature.
                                                        Eagletron Inc.
                                                        6 Hoskin Ave.
                                                   Toronto, ON M5S 1H8
                                                           Canada
                                           tel: 416-323-2233    fax: 416-598-5354

								
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