US Dealer Application Form

  Company Name
(Legal Name)		  
  Company Address
(2 lines max)		 DUNS Number
(Digits only)
  City   State
  Country   Zip Code
  Company Telephone
(Only numbers allowed)		  
  Accounts Payable
Email Address		  
  Years in Business   Accounts Payable
Telephone
(Only numbers allowed)
  Credit Requested ($)   Tax ID #
Bank Reference
  Name Contact
  Address Account Number
  Email Address Telephone
(Only numbers allowed)
 
Trade References (minimum 3) - Email address is required for the bank and trades provided.
 
Reference 1 Reference 2 Reference 3
Name Name Name
Address Address Address
Telephone
(Only numbers allowed)		 Telephone
(Only numbers allowed)		 Telephone
(Only numbers allowed)
Email Email Email
 
Applicant Information
 
Name Title Email
 
Terms: Orders are shipped OAC under regular terms of Net 30 unless otherwise stated.
By signing below as legal principal or agent of the above mentioned company having authority to represent the company in this matter, I agree to the above terms and give authorization to the Bank and Trade References to release credit information on the company to Allseating Corporation or a third party company acting on behalf of Allseating Corporation. I agree and understand that all necessary collection and legal expenses, including but not limited to collection agency fees, reasonable attorney fees, court costs, filing fees, interest and service fees may be charged in the event of default or failure to pay for goods and services provided. I acknowledge that Allseating Corporation reserves the right to charge interest at the maximum rate allowed by law in the event of default or failure to pay for goods and services sold and delivered. I acknowledge and agree that all charges incurred shall be considered due and payable according to the terms on the invoice.
 
  Signature Date  
 
  
 
5800 Aveury Rd,Unit 3, Mississauga, Ontario
Canada L5R 3M3
Email: holly.cossu@allseating.com
Website: www.allseating.com