NEW ACCOUNT/DEALER APPLICATION
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Please complete the following form and return it to us. All new accounts are on C.O.D. cash until your dealer application is returned. Company checks will be accepted with your completed dealer application.
BUSINESS NAME:
_________________________________________________________________ STATE SALES TAX #: ____________________________ FEDERAL TAX #: ___________________
OWNERS NAME:
_______________________________________ SS #: ______________________
OWNERS NAME:
_______________________________________ SS #: _______________________
BANK CHECKING ACCOUNT:
_________________________________________________________
Please list three trade references you
have accounts with, include address and phone number. 1 - _______________________________________________________________________________ __________________________________________________________________________________ 2 - _______________________________________________________________________________ __________________________________________________________________________________ 3 - _______________________________________________________________________________ __________________________________________________________________________________ Please include a picture of your store front, a copy of your telephone book listing, and a copy of your state tax certificate or license. A $25.00 service charge will be added to all returned checks. The undersigned applicant hereby gives written authorization to Wizzard High Performance, Inc., to contact the bank and credit references disclosed on this credit application, as well as credit bureau and/or credit reporting agencies and to obtain from such entities information Wizzard deems necessary to enable it to evaluate this credit application. Applicant's signature attests financial responsibility, ability and willingness to pay our invoices in accordance with our terms. I/We hereby agree in the event of default, to pay any reasonable collection cost and in the event the account is referred to an attorney, reasonable attorney's fees and costs. That the venue for legal action may be placed in the county and state from which the goods are purchased. Signature _____________________________________________________ Date _______________ Signature _____________________________________________________ Date _______________ Please complete the following information so we can service you better (it has no effect on your dealer status). Do you have an H.O. scale track in you shop? Yes ______ No ______ If yes please complete the following: Type of track: Plastic -- Tyco -- Tomy -- Life-Like -- Other ___________________________________ Commercial -- Manufacturer ______________________________ Rail height _________________ Table size _________________________________ Type of power 18 volt battery/Other _____________________________________________________ Road Course/Oval Longest straightaway _________________________________________________ Are you a member of any H.O./hobby organizations: (i.e. TOA, UFHORA, NRHSA) Yes ______ No _____ Please List: ________________________________________________________________________ __________________________________________________________________________________ Thank You! - Wizzard High Performance, Inc. |