New Account Application (8/30)

DATE*

DBA (IF APPLICABLE)

COMPANY NAME*

PHONE NUMBER*

CONTACT FIRST NAME*

CONTACT LAST NAME*

TITLE

WEBSITE

EMAIL*

(Invoices will be emailed to this address, unless otherwise noted.)

BILLING ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code

SHIPPING ADDRESS (If same as billing, leave blank)

Street Address

Street Address Line 2

CityState

Zip Code

TYPE OF BUSINESS (SELECT ONE)*

UPLOAD IMAGE OF STORE FRONT OR ONLINE STORE (IF APPLICABLE)

MAJOR MARKETS (SELECT ALL THAT APPLY)*

HOW LONG HAVE YOU BEEN IN BUSINESS?

HOW MANY STORES DO YOU HAVE?

WHAT ARE YOUR ANNUAL SALES?

HOW MANY EMPLOYEES DO YOU HAVE?

WHERE DID YOU HEAR ABOUT US?

PLEASE INCLUDE ANY ADDITIONAL INFORMATION YOU WOULD LIKE US TO CONSIDER:

SOCIAL HANDLES

TAX ID #

RESALE #

If a resale number can be issued in your state, then it must be filled in here or on the self certification page below. Without a Resale # or exemption by state, we cannot approve this application.

UPLOAD SALES TAX CERTIFICATE

PURCHASE ORDER REQUIRED?*

YESNO

EMAIL INVOICES ALLOWED?*

YESNO

ACCOUNT TYPE (SELECT ONE)*

CREDIT CARD OR ACH

IF SHIPPING TO MORE THAN ONE LOCATION, PLEASE PROVIDE A LIST OF ADDRESSES, CONTACT INFORMATION, AND PHONE NUMBERS.

The Bug Bite Thing, Inc. (BBT) has invested significantly worldwide, building a brand of strong recognition and high perceived value for the Product. By not adhering to the established MAP policy, a reseller can dramatically diminish or detract from the perceived value of BBT brand and the Product.

By signing, you agree the terms and conditions and the MAP Policy of Bug Bite Thing, Inc., which specifies that:

Bug Bite Thing can not be sold lower than the MAP retail price of $9.99
The Dealer is granted permission to sell Bug Bite Thing in their “BRICK AND MORTER” retail store or through their own proprietary website. BUG BITE THING MAY NOT BE SOLD ON A THIRD-PARTY WEBSITE SUCH AS AMAZON, EBAY, WALMART ETC. AND MAY NOT BE SOLD TO ANY OTHER RETAILERS OR EXPORTED OUTSIDE THE USA AT ANY TIME.

BUG BITE THING, INC. AUTHORIZED DEALER TERMS & CONDITIONS OF SALE

Click below to read the AUTHORIZED DEALER TERMS AND CONDITIONS
that outline the requirements for an Authorized Dealer to sell BUG BITE THING, INC.

CLICK HERE

MINIMUM ADVERTISED PRICING POLICY

Click below to read the Minimum Advertised Price policy for The Bug Bite Thing® suction tool
(the “Product”) will be effective (herein referred to as “MAP Policy”).

CLICK HERE

NAME*

DATE*

SIGNATURE*

By signing my name above, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

If you provide your Resale Tax ID AND uploaded your resale certificate, you DO NOT need to complete this section. You can submit your application. If it is not provided above, use this form if applicable to your state. Thank you.

UNIFORM SALES & USE TAX
RESALE CERTIFICATE - MULTIJURISDICTION

The below-listed states have indicated that this certificate is acceptable as a resale/exemption certificate for sales/use tax, subject to the instructions and notes on pages 2-6. The issuing Buyer and the recipient Seller have the responsibility to determine the proper use of this certificate under applicable laws in each state, as these may change from time to time. This form was revised as of December 9, 2020.

ISSUED TO SELLER

I CERTIFY THAT: NAME OF FIRM (BUYER)

ADDRESS

IS ENGAGED OR IS REGISTERED AS A:

and is registered for sales/use tax with the below-listed states and cities within which Seller would deliver purchases to Buyer and that any such purchases are for wholesale, resale, or ingredients or components of a new product or service to be resold, leased, or rented in the normal course of business. Buyer is in the business of wholesaling, retailing, manufacturing, leasing (renting), or selling the following:

DESCRIPTION OF BUSINESS

GENERAL DESCRIPTION OF TANGIBLE PROPERTY OR TAXABLE SERVICES TO BE PURCHASED FROM THE SELLER

STATE REGISTRATION, SELLER'S PERMIT, OR ID NUMBER OF PURCHASER


AL¹
AR
AZ²
CA³
CO^4,5
CT⁶
FL⁷
GA⁸
HI^4,9
ID¹⁰
IL^4,11
IA
KS¹²
KY¹³
ME¹⁴
MD¹⁵
MI¹⁶
MN¹⁷

STATE REGISTRATION, SELLER'S PERMIT, OR ID NUMBER OF PURCHASER


MO¹⁸
NE
NJ
NM^4,19
NC²⁰
ND
OH²¹
OK²²
PA²³
RI²⁴
SC
SD²⁵
TN²⁶
TX²⁷
UT
VT²⁸
WA²⁹
WI³⁰

I further certify that if any property or service so purchased tax-free is used or consumed by Buyer so as to make it subject to sales/use tax, Buyer will pay the tax due directly to the proper taxing authority when state law so provides or inform the Seller for added tax billing. This certificate shall be a part of each order that Buyer may hereafter give to Seller, unless otherwise specified, and shall be valid until canceled by Buyer in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.

Signature*

Date*

Date

NEW ACCOUNT APPLICATION

If you provide your Resale Tax ID AND uploaded your resale certificate, you DO NOT need to complete this section. You can submit your application. If it is not provided above, use this form if applicable to your state. Thank you.UNIFORM SALES & USE TAXRESALE CERTIFICATE - MULTIJURISDICTION

If you provide your Resale Tax ID AND uploaded your resale certificate, you DO NOT need to complete this section. You can submit your application. If it is not provided above, use this form if applicable to your state. Thank you.

UNIFORM SALES & USE TAX
RESALE CERTIFICATE - MULTIJURISDICTION