Apply for a Wholesale Account

Kimlor Wholesale Account Application

APPLICATION FOR AN ACCOUNT SALESMAN___________________________

REQUESTED LINE OF CREDIT: ____________________ OR PAYING WITH CREDIT CARD? YES OR NO

DO YOU HAVE AN ORDER? YES or NO YEARS IN BUSINESS____________________

BUSINESS NAME: ___________________________________________________________________

BILLING ADDRESS: _____________________________________________________________________

SHIP TO ADDRESS: ___________________________________________________________________________________
PHONE # ( ) ______________________ ______________________FAX # ( ) ________________________________

E-MAIL ADDRESS: ______________________________________________________________________

WHERE WILL YOU BE SELLING KIMLOR? ( ) RETAIL ( ) INTERNET

IF INTERNET, WILL YOU DROP SHIP? YES or NO

***For Internet Sales, all store names and third party marketplaces MUST be pre-approved by Kimlor***

Please list all business names under which you will sell Kimlor products
___________________________________________________________________________________________________

Please list all third party marketplaces through which you will sell Kimlor products (e.g., eBay, Amazon)
___________________________________________________________________________________________________

Primary WEBSITE: _______________________________________________________________________ (if applicable)

FEDERAL TAX I.D. # ______________________________________ RESALE# ____________________________

BUSINESS STRUCTURE: ( ) SOLE OWNER ( ) PARTNERSHIP ( ) CORPORATION

PRINCIPAL: ____________________________________________________ TITLE: ____________________________

PRINCIPAL: ____________________________________________________ TITLE: ____________________________
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BANK REFERENCE: ACCOUNT #: ____________________NAME OF BANK: _____________________________

ADDRESS: _____________________________________ CITY: ____________________ STATE: ____ ZIP: ___________

PHONE# ( ) ____________________________________________FAX# ( ) ________________________________

TRADE REFERENCES 3 VENDORS WITH WHOM YOU HAVE OPEN TERMS
(PLEASE INCLUDE FAX NUMBERS)

VENDOR NAME: _________________________________________ACCT# _______________________ STATE_______
PHONE# ( ) ___________________________________________FAX# ( ) _______________________________

VENDOR NAME: _________________________________________ACCT#________________________ STATE_______
PHONE# ( ) ___________________________________________FAX# ( ) _______________________________

VENDOR NAME: _________________________________________ACCT# _______________________ STATE_______
PHONE# ( ) ___________________________________________FAX# ( ) _______________________________

Applicant agrees to pay any collection cost incurred to collect the unpaid balance, including interest on unpaid balance as allowed by state law and any reasonable attorney’s fees incurred. The undersigned as an inducement to grant credit warrants that the information submitted is true and correct. You give authorization to investigate the credit references listed.

___________________________________________________SIGNATURE ________________________________DATE