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CONFIDENTIAL DEALER APPLICATION FORM Please copy this information to your word processor, fill out, and return or use the .pdf link below.
Store name: Contact name: Mailing address: Physical address: City: State: Zip code: Phone: Fax: Web site: Email: Years in business: Does your store offer diving certification classes: Certifying agency(s): What other major manufacturer lines do you carry: Gross annual sales: % Equipment: % Classes: Dry suits are what percentage of gross annual sales: What types of diving equipment do you sell: Do you rent diving equipment: Do you rent dry suits: Do you provide in store repairs for equipment: Dry suits:
CONFIDENTIAL CREDIT APPLICATION Please copy this information to your word processor, fill out, and return or use the .pdf link below.
FIRM NAME ________________________________________________ PHONE ( ) __________________ ADDRESS ____________________________________________________ FAX ( ) __________________ CITY _____________________________________ STATE ____________________ ZIP ___________________ CREDIT MANAGER _______________________________ PARENT CO. _______________________________ LEGAL ENTITY: CORPORATION _______ PARTNERSHIP _______ PROPRIETORSHIP _______ WE ARE INCORPORATED UNDER THE STATE LAWS OF: ____________________ SINCE ________________ PRINCIPALS NAME POSITION RES. ADDRESS PHONE 1. __________________________________________________________________________________________ 2. __________________________________________________________________________________________ 3. __________________________________________________________________________________________ ESTIMATED MONTHLY CREDIT NEEDED: $ ______________ EST. ANNUAL VOLUME: $ _________________ HAS THE COMPANY EVER FILED FOR BANKRUPTCY PROTECTION? __________ IF YES, WHAT CHAPTER? _________________________ HAS ANY COMPANY/CORPORATION OWNED BY THE COMMON PRINCIPALS OF THIS COMPANY EVER FILED FOR BANKRUPTCY PROTECTION? __________ IF YES, WHAT CHAPTER? ______________________ WE HAVE OPEN CREDIT ACCOMODATIONS WITH THE FOLLOWING BUSINESSES: SUPPLIER NAME ADDRESS PHONE # FAX# 1. __________________________________________________________________________________________ 2. __________________________________________________________________________________________ 3. __________________________________________________________________________________________ NAME OF BANK ____________________________ ADDRESS ______________________________________ PHONE NO ( ) ________________________ CONTACT _________________________________________ ACCOUNT NO. ___________________________________________________ THE INFORMATION AND STATEMENTS IN THIS APPLICATION ARE TRUE AND COMPLETE AND ARE MADE FOR THE EXCLUSIVE PURPOSE OF OBTAINING A CREDIT HISTORY IN EFFORT TO ESTABLISH AN OPEN CREDIT ACCOUNT WITH BUFFERS USA, INC. YOU ARE HEREBY AUTHORIZED TO OBTAIN ANY INFORMATION YOU CONSIDER APPROPRIATE FROM ANY SOURCE CONCERNING THIS APPLICATION. AUTHORIZED SIGNATURE ______________________________ TITLE _______________ DATE____________ |
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