Account Application | Competition Specialties, Inc

INTER-COMPANY USE ONLY
Sales Mgr App ________	Cust # ________
Credit Terms ________	Territory ________
Delivery ________	Cust Type ________
Approved By ________	Credit Limit $________

Please select your desired account type:

Credit Card	Cash / COD
Open Account	Company Check / COD

Account Type Desired	Requested Credit Limit $
Company Name	Phone/Fax
DBA, if different from above
Billing Address	City, State, Zip
Shipping Address, if different	City, State, Zip
Email
Business Location Commercial Building Internet-Based Home Residence	Is this a Corporation? Yes No
Years at this Location Years in Business	IRS ID Number Resale Number *NOTE: Businesses in California must fill out the California Resale Certificate form and submit separately.
In the Business of	Owner/Partner/Officer SSN
Previous Addresses	Other Location Addresses
Name of Manager	Name of Buyer
Name of Owners/Partners/Officers	Title of Owners/Partners/Officers
Bank information must be complete for consideration of open terms or company check.
Bank Name	Account Number
Bank Address	City, State, Zip
Bank Phone/Fax	Do you pledge to borrow on your accounts receivable? Yes No

Business References: Must be complete for consideration of open terms and company check!

Name Address	Phone/Fax City, State, Zip
Name Address	Phone/Fax City, State, Zip
Name Address	Phone/Fax City, State, Zip
Name Address	Phone/Fax City, State, Zip

I/we authorize CSI to investigate bank/business references listed for the purpose of obtaining an account with CSI and certify the information given to be current and correct. Upon submitting this application, I/we personally guarantee payment of all invoices in full and in accordance with the terms of sale set forth by Competition Specialties, Inc. (CSI). Copies of CSI terms and policies are available upon request, or online at http://www.compspecialties.com/terms. I/we fully understand this to be a binding obligation, which in the event the CSI brings legal action to enforce payment, I/we promise to pay past due service charges/collection agency charges/attorney fees and court costs.

Owner/Partner/Officer Name*

I certify I am the Owner, Partner, or Officer of my business, and agree to the above statement.

(For California Residents)
WARNING: This product can expose you to chemicals including LEAD and DEHP, which are known to the state of California to cause cancer and birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov. Wash hands following installation or handling.

*Competition Specialties, Inc. will not offer products to customers in the state of California that violate any Federal or State Laws, Vehicle codes 27156 and 38391 that are not legal to install, sell, offer to sell, or advertise any device, apparatus, or mechanism intended for use with, or as part of, any required motor vehicle pollution-control device or system which alters or modifies the original design or performance of any such motor vehicle pollution-control device or system, unless exempted by the CARB. Products that are legal to sell meet the requirements of Memorandum 1A of The Clean Air Act or have been assigned a CARB Executive Order (E.O.) number based on emissions testing. For further clarification go to www.arb.ca.gov.