PAM Distributing New Dealer Application 241230

Type of account desired:

CashCredit CardCOD / CompanyNet 30

Credit amount desired:*

Estimated monthly sales:*

Type of equipment to be purchased*

Company Name and DBA*

Website URL

Billing Address*

Street Address

Street Address Line 2

CityState

Postal / ZIP Code

Business Phone*

Fax

Mobile*

Email*

example@example.com

Accounts Payable Contact*

Phone*

Fax

Email*

example@example.com

Shipping Address*

Street Address

Street Address Line 2

CityState

Postal / ZIP Code

Type of location:*

Commercial Store FrontResidential OfficeOther

Year business was established:*

Years in business at current location*

Years in business at previous location

Please check the applicable business type:

ProprietorshipPartnershipCorporation

D&B #:

Sales tax exemption #:

Purchase to be for resale?*

YesNo

Have you filed bankruptcy within the past 7 years?

YesNo

I/We hereby authorize PAM Distributing Co. to verify and inquire about all information on both the company and any/all individuals whose information is submitted herein. I/We promise to pay for all goods and services purchased by terms and conditions stated. Furthermore, in the event that any goods or services are purchased on behalf of an above-named partnership, corporation or LLC, the undersigned hereby authorizes and directs PAM Distributing Co. to seek payment from the undersigned individual, in his or her individual capacity, in the event that said partnership, corporation or LLC fails to timely pay for such goods or services. In addition, the undersigned states he or she is properly authorized to act on behalf of said partnership, corporation or LLC and that any indebtedness that the undersigned contracts for on behalf of said partnership, corporation or LLC is a valid and binding debt of such partnership, corporation or LLC.

Applicant Signature*

Title*

Please print name*

Date*

Date

Application must be complete to expedite processing.

Any balance not paid within 60 days is subject to a late fee.

Verification*