Account Application
Please submit your information for consideration with Saf-T-Gard International, Inc. Completing our electronic template enables the most efficient processing of your request.
Business Name
*
D-U-N-S Number
Address - Primary Street (No. P.O. Boxes)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years at this address
*
Company Main Telephone Number
*
Please enter a valid phone number.
Company Main Fax Number
Please enter a valid phone number.
Company Main Website
*
Billing Address if not same as above
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Address if not same as above
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the name of your Saf-T-Gard Sales Representative?
*
If none, enter NA
How did you hear about Saf-T-Gard International?
Internet - web
Saf-T-Gard sales representative
Trade show
Networking
Magazine article or advertisement
Please select one or more
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Company Contact Information
Accounts Payable Contact Name
*
First Name
Last Name
Accounts Payable Contact Direct Phone Number
*
Please enter a valid phone number.
Accounts Payable Contact Email
*
example@example.com
Buyer or Purchaser Name.
*
First Name
Last Name
Buyer or Purchaser Title
*
Buyer or Purchaser Phone Number
*
Please enter a valid phone number.
Buyer or Purchaser Email. Email domain is required to be the same as the company website, unless a valid reason is provided below.
*
example@example.com
If email domain name is different from company website domain, please explain why.
What Industry Are You In?
Name of Parent Company, Subsidiaries or Affiliates
Parent, Subsidiary, or Affiliate Connection
Please Select
No parent, subsidiary, or affiliate
We are the parent company
We are a subsidiary of the company above
We are an affiliate of the company above
Business Structure
*
Please Select
C-Corporation
S-Corporation
Partnership
Limited Liability Corporation LLC
Limited Liability Partnership LP
Sole Proprietorship
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Business Identification
US Federal Tax ID Number or International VAT Registration Number
*
Are you purchasing goods for resale or are you tax exempt? If Yes, then please email current resale/tax exemption certificates for all states to credit@saftgard.com .
*
No
Yes
Are you applying for credit?
*
Yes
No
If applying for credit, credit limit requested
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Terms and Conditions
By clicking the Submit below, or signing with original signature, I hereby represent that I am authorized to submit this application and bind the business identified in this application, and that the information provided is for the sole purpose of obtaining credit and is warranted to be true. The business identified in this application acknowledges that this request is for an extension of credit for commercial purposes only and is not intended for the extension of credit for personal, family, or household purposes. In order to protect individual identities, unless an individual is intending to act as a guarantor for the purpose of securing credit and is required to provide guarantor information on this application, no personally identifying information (i.e. Social Security or driver license number, bank information, etc.) should be provided. The business identified in this application hereby authorizes all banks, financial institutions, trade reference sources, credit reporting agencies and others to release credit information. In the event of a conflict, the terms and conditions set forth above shall control over any terms and conditions set forth below.
Agreement
We certify that all of the information on this form is correct. With the signature below we authorize Saf-T-Gard International, Inc., to conduct a credit check for the purpose of determining credit worthiness in order to conduct business between our two companies. We further authorize the release of financial information by banks or other financial institutions for the same purpose. We understand that if there is no publicly available financial information available, we may request financial statements and/or annual reports for the last 2 fiscal years. We fully understand that the credit terms will be negotiated between our companies and agree to pay within these terms in consideration of extended credit. We agree that Saf-T-Gard International, Inc., retains title to all merchandise until paid for and, if the merchandise is consumed, destroyed, or re-sold prior to being paid for, Saf-T-Gard International, Inc., is granted a lien on the products produced or the proceeds of the sale of products produced or resold or services performed.
I/we agree to the terms and conditions above
*
Yes
Name of signer
*
First Name
Last Name
Title of signer
*
Email of signer
*
example@example.com
Signature
*
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