Wholesale Account Application Form Wholesale Account Application Form If you are human, leave this field blank. Legal Name Address Include complete address with City, State & Zip Code Check all that apply Does company have a D/B/A (Doing Business As) another entity name Does copany have a different "Ship To" address Sole Proprietor Corporation Partnership OtherOther Phone Number Fax Number Years in business Federal Employer Identification # Resale Tax Certificate # Terms Requested: Pay on Receipt (Required for accounts > $500.00/monthly spend) Net 30 (Minimum $500.00 monthly spend) Credit Card (Additional fees required, Seperate Form Required) Principals/Officers of Organization Principals/Officers of Organization Principals/Officers of Organization Bank Reference: Name of Institution Address Complete Address including city, state & zip Contact Phone Number Credit References: Name Include name of company and/or contact person Address Complete address including city, state & zip code Phone Number Fax Number Credit References: Name Phone Number Address Fax Number Special Instructions: Disclosure: By submitting this form, it is hereby warranted that the information submitted is true and correct and authorizes the disclosure of all pertinent credit information for the purpose of establishing an open line of credit with our company and hereby authorize Credit Bureau of South Florida, “CBSF” to deliver a credit report to: Seat Savers Plus, Inc., d/b/a Supreme Seat Covers, about my person and/or company upon request. Applicant/Debtor/Customer consents to be bond by a contractual agreement both personally and corporately to be responsible for the payment of all debt arising out of the purchase of goods/merchandise from Vendor/Creditor. Should any bankruptcy proceedings ever be filed by debtor, debtor agrees that in order to avoid manifest injustice and prejudice to creditor/vendor, all obligations due under this established business relationship shall be afforded a contractually secured priority. Debtor agrees to relief creditor of all costs associated in collections proceedings. Applicant submitting this form hereby acknowledges to be an officer or agent of Applicant with adequate ability and legality to enter into such agreement.