Dealer Application

DEALER APPLICATION AND SALES AGREEMENT
Please select one option below that best fits your requirements.
COD - Customer Check Acceptable COD / Cash - Cashier's Check / Money Order
Open Account (Select Amount)   $1000 $1500 $2500 $3500 $5000 $7500
Credit Card       Visa MC AMEX         ATM Card         Debit Card
  Card No.
Exp. Date on Card     Phone
Name on Card
Statement Address
City State Zip
IMPORTANT: Please fill in completely and sign.
The following statement in writing is made by the applicant for the purpose of obtaining merchandise from JADE ELECTRONICS on credit, and JADE ELECTRIONICS should rely on all information as correct. Applicant authorizes JADE ELECTRONICS to contact any references given and inquire of them about credit history. Upon the approval of this application, applicant agrees to abide by the terms and conditions of sale. Applicant further agrees to notify JADE ELECTRONICSin writing within five days of any change of ownership, address, telephone, authorized purchasing agent(s), banks, transfer of listed assets, or other facts set forth below.

GENERAL INFORMATION
Legal Name of firm
Name or Parent Company (if subsidiary)
Principal Business Address
City, State, Zip
Type of business
At Present Location since (date) Year Business Established
Phone Fax E-mail
Corporation Partnership Sole Proprietorship Warehouse Store Front Other (specify)
President Vice President
Treasurer Secretary
PRINCIPALS: Owner Partner
Accts. Payable Manager and Phone Number

BANK REFERENCE *Must be completed & be a Business Account*
Bank
Address
City, State, Zip
Bank Credit Line: Secured Yes No

SS# ________________________________ Account No.
Phone
Contact
Personal Guaranty Yes No

Date of Birth _________________________

I, authorize my bank to release any necessary information to JADE ELECTRONICS for their confidential use in processing my application for check approval.

Signature ______________________________________________ Title Date

APPLICATION CONTINUED FOR ESTABLISHING ACCOUNT

TRADE REFERENCE: ***This section must be completed to set up an account with JADE. A minimum of four (4) references are required and must be industry related.***

Name

Address

Phone

City, State, Zip

Please Check Appropriate Box: UCC Filings Floor Planned Personal Guarantee None

Name
Address

Phone
City, State, Zip

Please Check Appropriate Box: UCC Filings Floor Planned Personal Guarantee None

Name
Address

Phone
City, State, Zip

Please Check Appropriate Box: UCC Filings Floor Planned Personal Guarantee None

Name
Address

Phone
City, State, Zip

Please Check Appropriate Box: UCC Filings Floor Planned Personal Guarantee None

CREDIT REQUIREMENTS : IMPORTANT - Please answer the following questions!
Credit Amount Requested: $
Your Authorized Purchasing Agent
Would you be willing to:
Sign a Personal Guaranty YesNo
Accept a UCC Filing on Behalf of JADE ELECTRONICS Yes No

IF YOU HAVE REQUESTED A CREDIT LINE LARGER THAN $3,500, PLEASE ATTACH A CURRENT FINANCIAL STATEMENT.
The undersigned hereby certifies that above information is true and current, and in addition to the foregoing, the undersigned promises to pay for all purchases in accordance with JADE ELECTRONICS terms of sale. If at any time the undersigned is unable to pay for said purchases when due, the undersigned agrees to pay, and authorizes JADE ELECTRONICS to bill my account with interest computed at 2% per month (24% per annum) on any past due amount or the maximum prevailing rate allowable under the law of state governing the transactions contemplated by this credit application. If it becomes necessary for JADE ELECTRONICS to incur collection costs for any amount due under this agreement, the undersigned promises to pay additional collection costs including reasonable attorney fees. Upon acceptance by JADE ELECTRONICS , this application will constitute a sales and purchase agreement.
Facsimile transmission of signature shall be enforceable against party signing.
Signature (Owner, Officer or Authorized Agent)

Company (Legal Name)
Date

FOR OFFICE USE ONLY: Date Opened ____________ Limit _______________
Notified _____________________ By ________ Salesman ________ Type __________
Account Number _{_________________}
Upon completion of credit application, print out and fax us at (215) 322-2891 or print out and mail to JADE ELECTRONICS, 275 Andrews Road, Trevose, Pa 19053.