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RESELLER APPLICATION FORM
Company Information
Company Name:
DBA:
Street Address:
(Address Line 2):
City:
State:
Zip Code:
Telephone:
Fax:
Website URL:
Primary Contact:
Title:
Email:
Phone:
Description of Business
Nature of Business:
Retail
Wholesale
Distributor
Systems Integrator
OEM
Other:
Ownership:
Corporation
Partnership
Proprietorship
Other:
Date Established:
No. of Employees:
Reseller certificate #:
Dun & Bradstreet #:
Marketing Profile:
Marketing Profile:
Sales Territory:
Local
Regional
National
International
Primary Marketing Channel:
Retail
Store Mail
Order
E-commerce
Other
No. of Stores:
Annual Sales Volume:
Sales Territory:
Do you advertise:
Yes
No If !ˇ±yes!ˇL, where?
Trade References
1)
Company Name:
Nature of business:
Contact Person:
Address:
Address (Line 2):
URL:
Telephone Number:
Fax Number:
Payment Terms:
Account Number:
Credit Line:
# of years purchasing from this company:
2)
Company Name:
Nature of business:
Contact Person:
Address:
Address (Line 2):
URL:
Telephone Number:
Fax Number:
Payment Terms:
Account Number:
Credit Line:
# of years purchasing from this company:
3)
Company Name:
Nature of business:
Contact Person:
Address:
Address (Line 2):
URL:
Telephone Number:
Fax Number:
Payment Terms:
Account Number:
Credit Line:
# of years purchasing from this company:
Bank Information
(One application form per Bank)
Name of Bank:
Branch Address:
Address:
City:
State:
Zip code:
Telephone:
Checking Account #:
Saving Account #:
In order for JU-SOFT to extend credit for the purchase of JU-SOFT products and for other good and Valuable considerations, we hereby, convey, grant and transfer to JU-SOFT a purchase money security interest in the products and proceeds there from until we perform all our obligations hereunder. We further agree to pay all collection fees, reasonable attorney fees, court costs and other expenses incurred by JU-SOFT. By signing this agreement, I/we authorize the release of credit and banking information to JU-SOFT.
Signed by _______________ on this ____ day of ________ 20______
X________________________________________________________
Authorized Signature Print name and title
An authorized bank officer should fill out the following info.
Account No:
Type of Account:
Date Opened:
Current Balance:
Average Balance:
NSF:
Account Rating:
Comments:
Credit line:
Date opened:
Maturity on:
Current balance:
Credit line: Secure Unsecured
Payment Experience: Prompt Slow
Days
Prepared by:
Bank officer (please print)
Title:
Signature: ________________________________________
Date: ____________________________________________
10F-2, No.25, LANE 169, KANG NING STREET, HSI CHIH CITY, TAIPEI Country, TAIWAN
TEL:+886-22695-5343 FAX+886-2 2695-8791 E-mail:
sales@jusoft.com.tw
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