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reseller_application

VIEWS: 12 PAGES: 7

									                             You may type information directly onto this form & print
                            Use this Cover Sheet to return your information to Ingram Micro

                                      Please Allow 2-3 business days for processing




To: Ingram Micro New Business Development

Phone Number: 1-800-456-8000 Ext. 41
Fax to: (716) 616-1600
E-Mail: NewAccounts@ingrammicro.com
From:

Company Name _________________________________                                    Main Contact ___________________________________

Phone Number _________________________________                                    Fax Number ____________________________________

Or by Mail:         Ingram Micro Inc.
                    New Accounts
                    1759 Wehrle Drive
                    Williamsville, NY 14221

               Checklist: The following must be completed before application will be processed.
                  Any Required fields left blank will result in a delay of your account set-up

   Credit Card Authorization Form (Page 1)                                                 Completed & sign Reseller Application (Pages 2 thru 5)

   Completed and signed Uniform Sales & Use Tax Certificate-                               Financial Statements (Optional)
   Multijurisdiction for each state in which you are registered (Page 7)
                                                        Credit Card Authorization Form
      Your application will not be processed until this form is fully completed and received by Ingram Micro.
                       Credit card is the only method of payment accepted for the $100 fee
                                    This fee will be refunded if requirements are met*
Company Name                                                            Card Holder’s Name (as shown on statement)


City, State, & Zip (as shown on statement)                             P       Number                                     Fax Number

Credit Card:         Visa      Master card       Discover (we Do NOT accept American Express)


Expiration Date                                        Credit Card#                                           3- Digit# on back of credit card
                                                                                                                                                     ________
Name of Bank Issuing Credit Card                                                  Issuing Bank’s Toll Free #



I hereby authorize Ingram Micro Inc. to debit my credit card for the application fee of $100 as agreed. I acknowledge this transaction is
for account set-up purposes only. All reseller applications submitted to Ingram Micro will be subject to a refundable application fee of
$100 if the application is approved. *This fee will be refunded after one hundred twenty (120) calendar days to new customers whose
accounts show net sales of $1,500 or more in billed product during the first sixty (60) calendar days following the opening of the account.


Signature


                             Please Note: The cardholder must be one of the owners/officers named on the reseller application.
This authorization will be used upon approval of your reseller application. Once approved, the application fee of $100 will be applied to the credit card.
Please note that the credit card information will be kept confidential and the signature will be kept as your authorization for Ingram Micro, Inc. to debit the
amount on the credit card. For your reference, Purchase Order # of “NAF” will be used on this invoice.




                                                                           Page 1 of 7
                                                                                                                                         Account Number
                                                                                                                                         A
                                                                                                                                        F
                                                                                                                                      ( For Office Use Only)
                                                                                                                                                           )

                                                                          TION
                                                          RESELLER APPLICAT

      n           ss          n
Section 1 – Busines Information
 Do you now or have y
      u             you ever had an Ingram Acco
                                 a            ount                  Yes      No      Annual sales revenue of your business ----------Select--------------
      unt
 Accou # ________   ____________ _________


       B           e
 Legal Business Name (As it appears on Business License)
                                    o


      ess        e
 Busine Trade Name – DBA (Requir if using a DB Name)
                               red           BA



      ess         ress (Must be ac
 Busine Street Addr                                b
                                 ctual location of business. No P.O Boxes)
                                                                  O.                       ty
                                                                                         Cit                                State           Zip



 Billing Address         S
                         Same as Business Address                                          ty
                                                                                         Cit                                State           Zip



                    ress
 Shipping Street Addr                Same as Business Addr
                                          a              ress                              ty
                                                                                         Cit                                State           Zip



      ess        ddress
 Busine Website Ad


      ess       mber (Land Line)
 Busine Phone Num                                    Cell Phone #                         B
                                                                                          Business Fax #                siness Toll Free #
                                                                                                                      Bus              e



      B             lished
 Date Business Establ


      ax
 Fed Ta ID#



      #
 D & B# (If Known)



      rized Purchase
 Author            er



       Address
 Email A


      rized Purchase
 Author            er


       Address
 Email A



       erms Requeste
      Te           ed                    et
                                        Ne Terms (Will re                                  oval.)
                                                        equire Ingram Micro review and appro
 *Please choose your prefe
       e                ferred
 method of payment. Regarrdless of       Cr             ount Requeste $ ________
                                          redit Limit Amo           ed         _______
 payment terms selected,
 applicat
        tion processing wi not
                         ill              redit Card ( Dis
                                         Cr                           rcard & Visa on
                                                         scover, Master             nly) or Prepay W
                                                                                                   Wire Transfer
 be delay
        yed.


       ompany is
 This Co                                  ublic, Stock Sy
                                         Pu                         _
                                                        ymbol _______
       k
 (check one)
                                          f                             ent
                                         If subsidiary of Public Co. Pare Co. Name:_          ____________
                                                                                   ____________          __

                                          rivate
                                         Pr
               Public Companies-          ction 4
                               -Skip to Sec



                                                                           Page 2 of 7
     ate                ete
 Priva Companies – Comple the rest of this section
       -Corp, State of Incorporation
      C-                                        ----Select----

      S-Corp, State of Incorporation            ----Select----

       LC
      LL

       le           hip
     Sol Proprietorsh

      rtnership
    Par

                  mpany (if applicable)
 Name of Parent Com


                    s
 Name of Subsidiaries (If applicable) (or attach list)


      n           Information
Section 2 – Owner I
        er              y                   an
 Custome Agrees to Notify Ingram Micro of any changes of own
                                                           nership of it’s busine within ten (10) days, as set for th herein by certifie mail to the follow
                                                                               ness             )                   he                 ed                                  ram
                                                                                                                                                         owing address: Ingr
        nc.,           Drive, Williamsville, NY 14221-7887
 Micro In 1759 Wehrle Dr                     N
       t              th          ater ownership in business, in order by grea
2A- List all owners wit 25% or grea            p               n                          ip
                                                                             atest ownershi percentage. If there are no owners with
                      hip
25% or more ownersh check here
     r
 Owner 1 Name                                                                                  age of Ownersh
                                                                                        Percenta            hip                  %


     r
 Owner 2 Name                                                                                  age of Ownersh
                                                                                        Percenta            hip                  %


     r
 Owner 3 Name                                                                                  age of Ownersh
                                                                                        Percenta            hip                  %


     r
 Owner 4 Name                                                                                  age of Ownersh
                                                                                        Percenta            hip                  %


      Personal Credit Information of Owners
 2B – P                           o
      red : if Compan is a Sole Pro
 Requir             ny            oprietorship or Partnership

 Option                           g              d                                          p             ke          ro            the
      nal: if Company is requesting net terms and is not a Sole Proprietorship or Partnership and would lik Ingram Micr to consider t
      nal           e                            on.
 person credit of the owner (s) in their evaluatio

 The und                 dual (s), who is/a the principal( of the credit a
         dersigned individ                are            (s)                                                the
                                                                          applicant or a sole proprietor of t credit applica                 that his or her
                                                                                                                            ant, recognizing t
 individu credit history may be a factor in the evaluation of the credit history of the app
        ual                               r                                               plicant, hereby co                uthorizes the use of a consumer
                                                                                                            onsents to and au                e
 credit report on the unddersigned by abo named business credit granto in the credit ev
                                          ove                             or               valuation process.
     r
 Owner 1 Name


                    ber
 Social Security Numb


                   s
 Home Street Address                                                                     City                          State                        Zip


     r             )
 Owner 1 ( Required)

                                                                            ere
                                                                 Must sign he after printing

     r
 Owner 2 Name

                    ber
 Social Security Numb

                   s
 Home Street Address                                                                     City                          State                        Zip


     r
 Owner 2 ( Required)

                                                                             here after printing
                                                                   Must sign h



                          I CREDIT CA
                          IF                  PAY IS BEING REQUESTED YOU MAY SK TO SECTI
                                    ARD OR PREP          G         D          KIP      ION 4



                                                                                Page 3 of 7
Section 3 – Credit Information for Net Terms Request
Section 3A, 3B & 3C are required for ALL Net Terms Requests
 3A -Financial statements may be required to extend trade credit. You will be contacted if they are needed, or you may include with this
 application when returned. Please include a minimum of the prior two year’s income statement & balance sheet, and interim financials if
 available.
 Person to Contact for Information or Financial Questions:

 Name

 Title

 Phone

 Email

    check here if Financial statements are attached to this application

 3B – Do you currently finance any of your computer purchases through flooring or leasing programs?
    Yes (Complete information below)

     NO
 1. Finance Company Name


 Dealer #


 Finance Company Telephone Number


 2. Finance Company Name


 Dealer #


 Finance Company Telephone Number


 3C – Trade & Bank References
     Check here if you have attached a separate trade and bank reference sheet rather than completing below
    (Additional sheet must be signed)

 Trade References (Preferably in the Computer Technology Industry)
 1. Company Name


 Company Phone #


 Company Fax #


 Account Number


 Contact Name


 2. Company Name


 Company Phone #


 Company Fax #


 Account Number


 Contact Name


                                                                Page 4 of 7
Section 3C- Con’t
 Bank RReference

      Name
 Bank N


      Telephone #
 Bank T


      Fax # (if Known)
 Bank F              )

      ing Account #
 Checki

      gs
 Saving Account #

       f             nt
 Line of Credit Accoun #

      nt          me
 Accoun Officer Nam (If known)


       on
 Sectio 4 – Export Information
       ny           chases be for Ex
 Will an of your purc              xport?                          Yes        NO
       ,             ete          t               Q
 If Yes, Please comple and submit the exporter Questionnaire with this appli    ication. Export    ters must also read the inform    med Exporter
 Inform                           ents can be fou
       mation. Both of these docume             und at http://www.ingrammicro.com/vistor/potentialreseller/resellapexport.pdf In the event you intend
 to purchase product to be exported by Ingram to your customer overseas, a seperate Internal Fulfillment Agreement(IFA)
 will be required. Contact Ingram Micro Sales for more information once your account is established.




                       IN ORDER NOT TO DELAY YOUR ORDERING A
                        N            T                                  SE         E          ROVIDED ALL
                                                           ABILITY, PLEAS MAKE SURE YOU HAVE PR
                        NFORMATION REQUESTED.
                       IN            R
                        LEASE NOTE: ACCOUNTS THA HAVE NO SALES ACTIVITY WITHIN A 12 MONTH PERIO WILL BE
                       PL                      AT                                             OD
                        ELETED FROM OUR SYSTEM.
                       DE            O



This application and agre  eement is submit                   t                o
                                             tted by applicant to Ingram Micro Inc. (Ingram M                                    to
                                                                                               Micro), a Delaware corporation, t obtain trade credit. Ingram M    Micro
reserves the right to dec  cline credit to any applicant. I n the event credit is extended to a                 m                                                 er
                                                                                               applicant, Ingram Micro reserve s the right at an y time thereafte to
change o revoke such cr
         or                 redit for any reas
                                             son, including bu not limited to, credit policy cha
                                                             ut                                               m,
                                                                                               anges by Ingram applicant’s fina                                   ment
                                                                                                                                 ancial condition, applicant’s paym
record, aapplicant’s failure to meet sales volume requirements established by Ingram Micro and/or applica
                           e                 v                                                 o,                                of
                                                                                                               ant’s utilization o such credit limit. All product saales
         am
by In gra Mi cro to a p    pplicant wi ll be subject t o Ingr                                 erms and Condit
                                                              ram M icro’s sta ndard Sal es T e                                  hed
                                                                                                                tions as p ublish o n In gram Micro’s w ebsite at  e
                           at                le.             e                 ms
www.ingrammicro.com a the tim e of sal Any variance from those term and condition will be effectiv only if agreed to in writing by Ingram Micro p
                                                                                               ns               ve               d                y                prior
          me
to the ti m o f sale. Cu s  stomer a cknowle                 es
                                             edges a nd a gree tha t I ngram m send cust om marke ting a busi ness co m
                                                                              may              mer             and                                om              e
                                                                                                                                 mmunications f ro ti me to time via
various mmeans, including e-mail.
         er                ke               u                cro
Custome agrees to ma k payment in f ull to Ingram Mic for all amoun due according to Ingram Mic invoice(s). C
                                                                              nts              g               cro               Customer also ag grees to pay I ngram
         s                                                   ,                m                                                                   re
Micro, as interest, an am ount equal to 1 ½% per month, or the maximum provided by law (whichever is less) for invoice amounts that ar past due. Sho               ould
          r
customer default in any s                    ),
                            such payment(s) Ingram Micro s                     ght, without noti to customer, to declare all inv
                                                              shall have the rig               ice                                voice amounts d and payable. In
                                                                                                                                                 due
         nt                                 nce              or
the e ven I ngram Micro should c ommen any action o ac tions, or o th          herwise seek to enforce this agr reement a gainst customer, cus to omer a grees to pay
         ble
reasonab attorney(s) fe    ees, court costs, and other expen nses incurred by Ingram Micro, w whether or not su is filed. This a
                                                                                                               uit               agreement is strictly confidential and
         ansferable or assignable without prior written con
is not tra                                                   nsent of Ingram M Micro. Customer agrees that any change in liabil for any debts incurred to Ingram
                                                                                               r                y                 lity            s
Micro due to a chan ge in customer’s form of business, shall not be effec
                           n                 m                                ctive as to Ingram Micro, until In
                                                                                               m               ngram Micro rece                   ce               e
                                                                                                                                 eives actual notic of th e change by
certified mail. T his appli ication and agree                construed, interp
                                              ement shall be c                                                                   with
                                                                              preted, and enfo rced under and in accordance w the in ternal laws of the State of    e
California excluding its c
          a,                conflicts or choic of law rule or principles which might refer to the law of anot
                                             ce              r                 h                                ther jurisdiction. Ven ue shall be in O range County,
                                                                                                                                                  e
          a,               y,                d
California or Erie County New York, as determined by In      ngram Micro.


                                                                          ature Sectio
                                                                      Signa          on
      ant
Applica hereby ag                f            d
                    grees to the foregoing and authorizes t
                                                          the release of credit and b
                                                                       f            banking information to Ing          by
                                                                                                             gram Micro b
       erences listed on this app
the refe            d                                     ust
                                plication. The following mu be comple  eted in order to have an account


___________________   ____________   ____________               __
                                                     ____________                      ______           ____________
                                                                                             ____________                     ____________
                                                                                                                   ____________          ___
                                                      quired)
Owner/Partner/Corporate Officer Name- Please Print (Req
                      e               P                                                      uired)
                                                                                   Title (Requ


___________________   ____________   ____________              __
                                                    ____________                        As of th _______ day of ___________
                                                                                               his         y              ______________             ___
                                                                                                                                       _____, 20______
                                                    uired)
Owner/Partner/Corporate Office Name – Signature (Requ
                      e




                                                                             Page 5 of 7
                                  STOP: IMPORTANT TAX INFORMATION – Resale Tax

Ingram Micro is a distributor/wholesaler.

To establish and maintain your account, we require that you provide us with a Resale Certificate valid in the state where you
are lo cated, as well a s a ny other state in which you are regi stered, a nd th at y ou upd ate your certificate(s) on a periodic
basis in accordance with state laws and/or Ingram Micro policy. Our Resale Tax Department will notify you by mail when an
updated certificate is required. F ailure to provide an updated certificate may result in delayed shipments, rejection of yo ur
orders, and/o r the clo sure of your acc ount. Orde rs that are drop-ship ped may be subject to sale s tax if you have not
provided Ingram Micro a Resale Tax Certificate for the ship-to location. The Resale Certificate must include:


1.   Legal business name
2.   Business trade name(s); DBA
3.   Business address and phone number
4.   Type of business as registered with your state
5.   General description of business
6.   State sales registration number of each state in which you are licensed for resale
7.   Signature of owner or officer signing application
8.   Name and title of person signing certificate
9.   Date certificate is signed

Along with your state registrations you are required to provide the following forms/information if you ask to drop ship to the
following states:

New York                       Every customer must complete a New York ST-120 Resale Certificate
                               Part 1 or Part 2 as applicable


Pennsylvania                   Every customer must complete a PA REV 1220. If your company does not have a
                               Pennsylvania Sales Tax number due to not having nexus in PA, please complete
                               the PA REV 1220 and include the company's home state tax ID, the state
                               registered in and an explanation on line 7 as to why not registered. Example "no nexus"

Illinois                       If your company is not required to be registered in Illinois due to lack of nexus in the state,
                               please indicate "no nexus" on the Illinois line of the Uniform Sales & Use Tax Certificate-
                               Multijurisdiction form.


PLEASE NOTE: Ingram Micro has special sales tax requirements for shipment to the following 3 States and sales tax
will be applied to all shipments to those states unless the stated information is provided.

California                     A resale certificate with valid California tax ID number.

Massachusetts                  A Massachusetts state specific ST-4 Resale certificate that includes a valid Massachusetts
                               tax ID number.

Tennessee                      A resale certificate with a valid Tennessee tax ID number.

If you have any questions, please contact your Sales Representative or Resale Tax Department prior to requesting Ingram
Micro to ship to any of these 3 States.

If a state in which you are registered for resale does not accept the attached Uniform Sales & Use Tax Certificate-
Multijurisdiction, please call our New Accounts Department at (800)456-8000, ext. 41 to obtain the appropriate form.




                                                           Page 6 of 7
                                   UNIFORM SALES & USE TAX CERTIFICATE – MULTIJURISDICTION

The below-listed states have indicated that this form of certificate is acceptable, subject to the following notes. The issuer and the recipient have the
responsibility of determining the proper use of this certificate under applicable laws in each state, as these may change from time to time.

Issued to Seller:   INGRAM MICRO INC.                                                                                            Account Number
Address:            1759 Wehrle Drive                                                                                          (For Office Use Only)
                     Williamsville, NY 14221

I certify that:
Name of Firm: _____________________________________________                        DBA Name: __________________________________________
                 (Required Name of Firm)                                                             (Required if Using a DBA)

Is engaged as a registered: (Required -- Please check all that apply)
    Lessor (See Notes)        Manufacturer      Retailer
    Seller (California)      Wholesaler        Other ____________________________________


Street Address: ____________________________________ City, State, & Zip: _________________________________________________
                 (Required Street Address)                                      (Required City, State & Zip)
and is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases are for wholesale,
resale, ingredients, or components of a new product or service to be resold, leased, or rented in the normal course of business. We are in the business of
wholesaling, retailing, manufacturing, leasing (renting) the following:
Description of business: ________________________________________________________________________________________________
                                           (Required Description of business)
General description of tangible property or taxable services to be purchased from the seller: Computer hardware, software, and/or related items

You are required to complete the following for all state(s) in which you are registered unless it is not listed or a state specific form is required as outlined
below.
 Click here for instructions 1-21 regarding Uniform Sales Use Tax Certificate
Alaska, Delaware, Montana, New Hampshire, & Oregon do not require a resale certificate, but we do require this form be completed, with the
exception of the tax number, to serve as documentation that product purchased from Ingram Micro is for resale:
                        State Registration,                                    State Registration,                                       State Registration,
State                  Seller’s Permit, or ID          State                  Seller’s Permit, or ID             State                  Seller’s Permit, or ID
                       Number of Purchaser                                    Number of Purchaser                                       Number of Purchaser

Alabama 2                                              Louisiana            USE R1064 or R1055 FORM              Ohio 26
Arizona 22                                             Maine 9                                                   Oklahoma 16
Arkansas                                               Maryland 10                                               Pennsylvania
California 3                                           Massachusetts              USE ST-4 FORM                  Rhode Island 17
Colorado 1                                             Michigan 11                                               South Carolina
Connecticut 4                                          Minnesota 12                                              South Dakota 18
Dist. of Columbia 5                                    Mississippi                                               Tennessee
Florida 23               USE DR-13 FORM                Missouri 13                                               Texas 19
Georgia 6                                              Nebraska 14                                               Utah
Hawaii 1, 7                                            Nevada                                                    Vermont
Idaho                                                  New Jersey                                                Virginia                  USE ST-10 FORM
Illinois 1, 8                                          New Mexico 1, 15                                          Washington 20       USE RESELLER PERMIT FORM
Indiana                  USE ST-105 FORM               New York                 USE ST-120 FORM                  West Virginia        USE STREAMLINE FORM
Iowa                                                   North Carolina 25                                         Wisconsin 21
Kansas                                                 North Dakota                                              Wyoming              USE STREAMLINE FORM
Kentucky 24


further certify that if any property or service so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax, we will pay the
tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be a part of each order,
which we may hereafter give to you, unless otherwise specified, and shall be valid until cancelled by us in writing or revoked by the city or state.

Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.

Authorized Signature (Required): ___________________________________________________ (Owner, partner, or corporate officer)


Title: (Required)__________________________________________ Date: __________________________(Required)

*State specific forms may be downloaded from our website www.ingrammicro.com with the following exceptions: for a Florida DR-13 form, please contact the
Florida Department of Revenue at 941-361-6001; for a New Mexico form, Please contact the New Mexico Taxation and Revenue Department at
505-841-6200. If you have any questions, contact the New Accounts Department at 1-800-456-8000, ext. 41.




       Clear form & Start over                                               Page 7 of 7                                                    Done & Print

								
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