Distributor Information


(*) = required field

Are you an end-user or a reseller? (*)
End-User
Reseller

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If you resell, whom do you sell to?

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Major lines that you resell (*)

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What geographic areas do you cover? (*)

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Number of outside sales people (*)

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Number of inside sales people (*)

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How many locations do you have? (*)

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Square feet of warehouse space (*)

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Are you replacing another line with Franmar products? (*)
Yes
No

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If yes, how much annual volume did you have with this product last year?

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List competing lines you handle (*)

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Do you sell to the consumer? (*)
Yes
No

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Do you have a display area? (*)
Yes
No

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Can customers pick up product at your location? (*)
Yes
No

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What are your store hours?

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Do you ship to customers? (*)
Yes
No

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If yes, which shipping methods do you use (UPS, FedEX, etc.)?

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Do you have a website? If so, what is it? (*)

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Billing/Shipping Information

Official Company Name (*)

Please type your full name.
Main Phone (*)

Please type your full name.
Main Fax (*)

Please type your full name.
E-mail (*)

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Billing Address (*)

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Shipping Address (if different)

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Business Information

Check One (*)
Corporation
Partnership
Proprietorship
Subsidiary
Division

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Years in Operation (*)

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Type of Business (*)

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D&B# (*)

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FEIN# or SS# (*)

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Sales Per Year (*)

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President/CEO (*)

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Treasurer/Controller (*)

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VP Finance (*)

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A/P Manager (*)

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Bank Information

Bank Name (*)

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Contact Name (*)

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Account Number (*)

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Fax Number (*)

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Complete Address (*)

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Trade References


Please list three suppliers whom you have had an active account within the past year, including contact name, complete address, phone number and fax.


Reference #1

Name (*)

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Contact (*)

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Address (*)

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Phone (*)

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Fax (*)

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Reference #2

Name (*)

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Contact (*)

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Address (*)

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Phone (*)

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Fax (*)

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Reference #3

Name (*)

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Contact (*)

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Address (*)

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Phone (*)

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Fax (*)

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Please enter the characters below.


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CUSTOMER'S AUTHORIZATION TO RELEASE BANK AND TRADE INFORMATION

Customer agrees to pay 1-1/2% interest per month on all balances owed more than (30) days from the date of invoice. Customer agrees to pay all costs of collection (including but not limited to court costs and reasonable attorney's fees up to $50,000) incurred by Franmar Chemical, Inc., in the event customer fails to abide by the credit terms extended.

By submitting this application I/we hereby authorize you to whom this application is made, or your agents, to investigate, my/our credit worthiness and will provide financial statements, tax returns etc., as you deem necessary

You will be asked to provide Franmar with copies of all tax exemption certificates.