Zyloware New Account Credit Application

Account Type

Select One Account Type Before Proceeding with Application. *

Direct Billing

Buying Group/Buying Network

Buying Group/Network Name:

Buying Group/Network ID#:

Business Information

Name of Business: *

Tax I.D. Number

DBA:

D&B Number:

Canadian Address?

Yes

Address: *

City: *

State: *

Zip: *

Country:

City: *

Province: *

Postal Code: *

Contact Name: *

Contact Email Address: *

Contact Phone: (no dashes) *

Please note by providing an email address you give consent to receive information on products and promotions and events from Zyloware Eyewear Canda ULC

Please note by providing an email address you give consent to receive information on products, promotions and events from Zyloware Eyewear.

At Present Location Since: *

In Business Since: *

State/Region of Registration:

Entity:

LLC

Corporation

Partnership

Proprietorship

Name of Company Principal Responsible for Business Transactions:

Title:

Email:

Phone: (no dashes)

Please note by providing an email address you give consent to receive information on products and promotions and events from Zyloware Eyewear Canda ULC

Additional Retail Locations

If there are no additional retail locations please proceed to the next section

Company Name:

Contact Name:

Address:

City:

State:

Zip:

Country:

City:

Province:

Postal Code:

Phone: (no dashes)

Email:

Company Name:

Contact Name:

Address:

City:

State:

Zip:

Country:

City:

Province:

Postal Code:

Phone: (no dashes)

Email:

Ordering Information

Are written purchase orders required?

Yes

No

Is merchandise for resale?

Yes

No

California Residents Only:

Sales Tax Yes

Sales Tax No

Resale Number:

Kentucky Residents Only:

Sales Tax Yes

Sales Tax No

Resale Number:

Frame Buyer:

Phone: (no dashes)

Fax:

Email:

Accounts Payable Contact:

Phone: (no dashes)

Fax:

Email:

Bank References

Institution name:

Officers Name:

Address:

Phone: (no dashes)

Fax:

Email:

Payment Terms

If prepaying by credit card, an account representative will contact you for further information

Terms:

Net 30 Days

Prepay via Credit Card

Other: Other:

Trade References

Trade #1

Company Name:

Contact Name:

Address:

Phone: (no dashes)

Fax:

Email:

Trade #2

Company Name:

Contact Name:

Address:

Phone: (no dashes)

Fax:

Email:

Terms & Conditions

The term and conditions appearing below are an integral part of this agreement between the Customer and Zyloware Corporation here in after referred to as the "Company". Sales tax will be charged unless a properly executed Sales Tax Exemption Certificate is with the Company.

No Merchandise may be returned unless a Company employee furnishes a Return Authorization Number.

If the return is approved, the Customer shall pay the cost of the return and any restocking fee imposed unless the Company otherwise waives the charges. Customer agrees to pay all invoices Net 30 days. Invoices unpaid thirty one days after the invoice date may be subject to a finance charge of 1.5% per month of part thereof or maximum rate said contract rate is deemed legally excessive.

Customer shall pay all costs of collection by the company of sums due for merchandise and/or services including the principle sum, interest thereon, attorney's fee for the collection of 25% of the total amount due but not less than $500.00 and the cost of the suit.

Customer hereby certifies that all information provided is true. In return for such extension of credit, customer hereby agrees to all foregoing terms and conditions, intending to be legally bound hereby.

Signature

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. I have read and agree to the Terms and Conditions as set forth. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.

The undersigned certifies the above information in this form to be tru and affirms that any credit given to me is extended upon the basis of such information. The undersigned consents to the obtaining of credit and/or personal information as may be reqired at any time inconnection with the credit hereby applied for any renewal or extension thereof and to the disclosure of anycredit information concerning the undersigned to any credit reporting agency or to any person with whom the undersigned has or proposes to have financial relations. the undersigned further acknowledges that I been informed of your prevailing terms for repayment and agree to pay interest charge of 1.6% per month (19.56% per annum), compounded monthly on any overdue balance until paid.

Signature *

clear

Account Manager Name: *

Account Manager Email

Date (MM/DD/YYYY) * +