ANZO RESELLER APPLICATION IMPORTANT NEW ACCOUNT INFORMATION

5150 Eucalyptus Ave Unit A Tel : 1 (909) 468 - 3688
Chino, CA 91710-5728 www.anzousa.com
RESELLER APPLICATION

IMPORTANT NEW ACCOUNT INFORMATION
Thank you for choosing Anzo USA as your premier source of automotive after market lighting and accessories component. To ensure that your account is set up in an efficient and timely manner so that you may start placing orders with Anzo USA, please help us to compile the following new account set up documentations:

· Copy of voided company check
· Copy of state tax resale and business license

Please be advised that before a proper term is set up for your account, your first order with Anzo USA will be processed on COD Cash/Cashier’s Check unless stated otherwise.

If you are not requesting COD company check or Net term, the bank reference is optional.

If you are requesting Net term, please also furnish your most recent two years Financial Statement along with application.

If you have already given an order to the Anzo USA sales representative, your order cannot be placed or shipped out until we receive your completed new account application forms. Upon receipt of these forms, your account will be set up and order will be processed accordingly. The approximate processing time is between 2 to 4 working days. We appreciate your interest in Anzo USA and look forward to providing you with the very best service and product selection possible. Thank you for your cooperation and we look forward to a mutually beneficial business relationship.

Please mail your completed forms to:

Credit Department Anzo USA
5150 Eucalyptus Ave Unit A Chino, CA 91710-5728
Phone : (909) 468 - 3688
Account Executive:
Ext:

I/We hereby apply to Anzo USA (hereinafter “Vendor”) for credit and/or an increase, update or reconfirmation of our existing account. The undersigned gives and grants Vendor permission to verify all information stated herein. I/We hereby agree that all credit granted and/or extended shall be repaid in a timely fashion.
Term/Credit Limit Requested
COMPANY INFORMATION
Company Name*
DBA
Address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State*
Zip*
Phone*
Fax
Entity
Sole Proprietorship
Partnership
Corporation
Other,
Federal Tax ID*
State Resale*
D & B #*
Type of Business*
Year Established*
At present location since
Financial Contact in firm*
Phone*
ext.
Name of Purchaser in firm*
Email*
example@example.com
PRINCIPALS of COMPANY
Name*
Title*
Home phone*
Address*

Address

Street Address Line 2

CityState

Zip
Social Security*
Email*
example@example.com
BANK REFERENCES
Bank Name
Contact Person
Address

Address

Street Address Line 2

CityState

Zip
Phone
Fax
Line of Credit
Checking Acct #
Saving Acct #
Loan Acct #
Bank Name
Contact Person
Address

Address

Street Address Line 2

CityState

Zip
Phone
Fax
Line of Credit
Checking Acct
Saving Acct
Loan Acct
TRADE REFERENCES
Company Name
DBA
Contact Person
Address

Address

Street Address Line 2

CityState

Zip
Phone
Fax
Email
example@example.com
Company Name
DBA
Contact Person
Address

Address

Street Address Line 2

CityState

Zip
Phone
Fax
Email
example@example.com
Company Name
DBA
Contact Person
Address

Address

Street Address Line 2

CityState

Zip
Phone
Fax
Email
example@example.com
IMPORTANT: Please complete Bank and Trade References for Net Terms approval. Kindly include current year end financial statements** with Net term requests

The undersigned hereby authorizes the above named bank(s) or credit reference(s) to release such information as in necessary to establish credit with our company.
Name*
Signature*

Clear
Title*
Date*

MonthDayYear
Date
** Note that all financial statements must include a balance sheet and income statement. All unaudited statements must be signed and dated by an owner/officer.

CONTINUING PERSONAL GUARANTEE
For goods and valuable consideration, including the extension of credit to the company or companies listed on this application (“customer”) from which I will benefit, do hereby personally guarantee and promise to pay on demand any obligation of customer to Anzo USA without regard for any claim of setoff, counterclaim or defense. I hereby waive notice of sales to customer, and of the terms thereof, and of non-payment or other default or dispute with Customer. I hereby waive any right to a jury trial and consent to all renewals and modifications of terms of sale or credit. This is a continuing and irrevocable guarantee and I hereby subordinate any indebtedness of Customer to me to that of Customer to Anzo USA.
Print Name*
Date*

MonthDayYear
Date
Signature*

Clear
Title*
Driver License*
State*
Social Security*
Home Address / Phone No.
** Please attach personal financial statements of guarantor and a copy of your Driver License and Social Security Card.**
Upload photocopies of your financial statements of guarantor, driver's license, and social security card*

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Security Agreement
1. The undersigned agrees that Anzo USA (“Seller”), will maintain a security interest in all goods that Seller sells and delivers to the undersigned (“Buyer”), and all proceeds thereof (“Collateral” Buyer will refrain from moving the Collateral from its present location and will advise Seller on demand as to the location of all collateral in its possession. Buyer will execute on demand a UCC-1 or similar financing statement to perfect Seller’s rights in the Collateral. If Buyer fails to execute such a document, Seller may do so and sign Buyer’s name. Buyer irrevocably appoints Seller as its attorney-in-fact to place said signature on the document and record it with the appropriate authority. 2. If Buyer fails to pay as agreed, or otherwise defaults, Seller may possess the Collateral, and may enter onto private property and any structure to do so. Buyer is obligated to assemble the Collateral. If the Collateral is repossessed, Seller may exercise all rights of the Uniform Commercial Code or the similar statutes in any state where the Collateral is taken. Upon repossession, the Seller may sell without notice and at private sale, to the greatest extent allowed by law, and may sell in any commercially reasonable manner. 3. Seller has all rights under law. All rights are cumulative. Buyer will reimburse the Seller for any loss, damage, cost or expense, including without limitation reasonable attorney’s fees and legal expenses, in connection with the exercise of any right or remedy pursuant to this Agreement. Service of process shall be effective if mailed to the applicable party at the address set forth herein. 4. Until payment is made in full of all obligations owing to Seller, Buyer will not assign or pledge the Collateral and will maintain the Collateral free and clear of all liens, claims, taxes and encumbrances, or any other third party interest (collectively, “Encumbrances” Any such assignment, pledge or Encumbrance shall be void. 5. The terms and conditions of this Agreement apply to all sales made between the parties. The price, term of payment, delivery information, and all matters including warranty information placed on the front or reverse of the invoice delivered by Seller in connection with the sale shall be the terms of sale. If no payment terms are specified, then the terms of payment are C.O.D. Time is of the essence. The terms of Seller’s invoice and this Agreement shall supersede any contrary terms in the Buyer’s Purchase Order. I/We agree to the above and state that all information in the credit application is true, and Seller may check all credit sources, and the credit of any guarantors. If any information is false, then Seller can declare all sums due and owing and exercise any right to the Collateral.
Print Name*
Company*
Signature*

Clear
Title*
Company Address*
Uniform Sales And Use Tax Certificate / Multi-jurisdiction
I certify that *
is engaged as a registered*

WholesalerRetailerManufacturerOther
Name of Firm (Buyer)*
Street Address*
City/State/Zip*
Phone*
State Reseller Certificate Number*
Please Attach a Photocopy of Your State Reseller Permit*

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And is registered with the state of*
and cities within your firm would deliver purchases to us and that any such purchases are

for wholesale, resale, ingredients or components of a new product to be resold, leased or rented in the normal course of business. We are in the business of wholesaling, retailing, manufacturing or leasing (renting) the following:
Description of business*
I/We hereby apply to Anzo USA (hereinafter “Vendor”) for credit and/or an increase, update or reconfirmation of our existing account. The undersigned gives and grants Vendor permission to verify all information stated herein. I/We hereby agree that all credit granted and/or extended shall be repaid in a timely fashion.
Signature*

Clear
Owner, Partner, or Corporate Officer
Print Name*
Title*
Date*

MonthDayYear
Date

AUTHORIZATION TO RELEASE CREDIT INFORMATION
Bank Name*
Address*

Address

Street Address Line 2

CityState

Zip
Phone*
Fax
Our company,*
Address*

Address

Street Address Line 2

CityState

Zip
Phone*
Fax
,hereby authorizes the above named financial institution to release credit information on the account(s) listed herein to Anzo USA. Please provide them with the complete information and send it back directly to them to expedite our request for credit. I/We understand that this information will be kept in the strictest confidence between your organization and Anzo USA
Checking Account Number
Saving Account Number
Loan Account Number
Line of Credit
Credit Limit
Signature

Clear
Owner, Partner, or Corporate Officer
Print Name
Title
Date

MonthDayYear
Date
BANK RATING
Checking Account
Savings Account
Opening Date

MonthDayYear
Date
Opening Date

MonthDayYear
Date
Current Balance
Current Balance
Average Balance
Average Balance
Number of NSF
Number of NSF
LOAN ACCOUNT
Credit Limit
Outstanding
Expiration Date

MonthDayYear
Date
Renewal Date

MonthDayYear
Date
Comments
Completed By
Title
Date

MonthDayYear
Date

CREDIT CARD AUTHORIZATION FOR PREPAID CUSTOMER
Company Name*
Address*
City*
State*
Zip*
Telephone*
Fax
Cardholder’s Name (Please Print)*
Driver License #*
State*
Credit Card Account #*
C V V #*
(the 3 digits number located on the front ot back of your card, usually at the top of the signature strip
Card Type*

VisaMasterCardDiscover
Expiration Date*

MonthDayYear
Date
Credit Card Billing Address*
City*
State*
Zip*
Cardholder’s Phone #*
I authorize Anzo USA to charge my credit card for all my Anzo USA account transaction. If the above credit card becomes invalid during the term(s) of my Anzo USA service(s) or if my account becomes delinquent, Anzo USA reserves the right to suspend my service(s) and my account may be subject to additional collection procedures and charges. All the information above will be confidential, please read carefully before signing below. By signing this form, I agree to the terms listed and authorize all information that I provided to be true and correct.
Cardholder’s Signature*

Clear
Date*

MonthDayYear
Date
Please attach a copy of front and back of the credit card and the driver's license*

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RESELLER APPLICATION

COMPANY INFORMATION

PRINCIPALS of COMPANY

BANK REFERENCES

TRADE REFERENCES

CONTINUING PERSONAL GUARANTEE

Security Agreement

Uniform Sales And Use Tax Certificate / Multi-jurisdiction

AUTHORIZATION TO RELEASE CREDIT INFORMATION

BANK RATING

LOAN ACCOUNT

CREDIT CARD AUTHORIZATION FOR PREPAID CUSTOMER

CREDIT CARD AUTHORIZATION FOR TERM CUSTOMER