DEUTZ Distributor / Dealer Application

DEUTZ Distributor / Dealer Service Partner Inquiry
Date Submited

MonthDayYear
Date

This document is an application only. Upon approval and review by DEUTZ Corporation, the applicant and the network service provider will agree upon applicant's non exclusive territory and their respective obligations, responsibilities and functions by signing a Service Dealer Agreement.

This submission is for?
Engine Group Requesting For?
Desired Scope
Desired Scope
Are you in Direct DEUTZ Power Center Territory
Do you have a corporate account with established DEUTZ credit that you will be using?
What is the DEUTZ GPA you would like to use for credit for the new locations?
Industry Type
Briefly explain your business approach to providing for the Full Service needs of the DEUTZ brand in your area.
Applicant Name

First NameLast Name
Applicants E Mail
example@example.com
Applicants Phone Number
Ex: 111 222 3333 (no dashes)
Applicants Phone Number LA

Country CodeArea CodePhone Number
Associated DPC Branch
Current GPA, if known, for requested location?
If unsure, leave blank
Company Name
WITHOUT Legal Designation
Legal Designation
Full Registered Legal Name
With Legal Designation
Company Name (Local Spelling)
With Legal Designation
Business Partner Type
Complete and provide Completed W-9 Tax Form.

IRS W-9 page
Please attach Completed W-9 Form

Browse Files

Cancelof
Selections below need to be related to the total organization purchasing, not just the single location. If you have an organization with multiple locations, please take that into account.
Debtor (choose from dropdown)
Yearly Expected Turnover Sales and Service Total
Debtor selecting >100K choose from dropdown)
Governmental Interaction / PEP
Answer to statement below

Military Business
Answer to statement below

Person To Complete Business Compliance Questionnaire Form For Company
Last Name
First Name
Email

How many locations do you want to sign?
Primary Location Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Primary Location Phone
Ex: 111 222 3333 (no dashes)
Primary Location Phone LA

Country CodeArea CodePhone Number
Additional Requested Location
- DEUTZ Corporation Credit Application
- DEUTZ CORPORATION
  
  3883 Steve Reynolds Blvd., Norcross, GA 30093 USA
  
  Phone (770) 564-7100 Fax (770) 564-7373
- 1 General Information
- Date
  
  MonthDayYear
  Date
- 1.1 Business Inquiry Information
- Applicant's Business Name
- Trade Name
- Applicant's Name
  
  First NameLast Name
- Applicant's Email Address
  example@example.com
- Applicant's Phone Number
  Format: +1 000 000 0000.
- Applicant's Phone Number LA
  
  Country CodeArea CodePhone Number
- If you are currently a Customer of DEUTZ Corporation, please provide GPA number
- Who at DEUTZ is your contact person?
  
  First NameLast Name
- Which DEUTZ Location are you working with?
- You have been automatically assigned to:
- 1.2 Tax & Purchase Information
- Federal Tax ID/CUIT/BN number
  Please N/A if not applicable
- Complete and provide Completed W-9 Tax Form.
  
  IRS W-9 page
- Please attach Completed W-9 Form
  
  Browse Files
  
  Cancelof
- Sales tax Exempt (only possible if U.S. customer)
- Please attach Tax Exemption Certificate
  
  Browse Files
  
  Cancelof
- 1.3 Address Information
- Physical Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Is Billing Address same as Physical Address?
- Billing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- 2 Financial Section
- 2.1 General
- Credit Terms Requested?
- 2.2 Accounts Payable Contact (A/P)
- A/P Contact
  
  First NameLast Name
- A/P Contact Phone Number
  Format: +1 000 000 0000.
- A/P Contact Phone Number LA
  
  Country CodeArea CodePhone Number
- A/P Contact Email
  example@example.com
- Do you prefer invoices/statements by email?
- Email address for Invoices/Statements
  example@example.com
- 2.3 Bank/Finance References
- 1) Institution Name
- Contact
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Institution Phone Number
  
  Country CodeArea CodePhone Number
- Institution Fax
  
  Country CodeArea CodePhone Number
- 2.4 Trade References
- 1) Firm
- Contact
  
  First NameLast Name
- Account Number
- Firm Phone Number
  
  Country CodeArea CodePhone Number
- Firm Fax Number
  
  Country CodeArea CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 2) Firm
- Contact
  
  First NameLast Name
- Account Number
- Firm Phone Number
  
  Country CodeArea CodePhone Number
- Firm Fax Number
  
  Country CodeArea CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 3) Firm
- Contact
  
  First NameLast Name
- Account Number
- Firm Phone Number
  
  Country CodeArea CodePhone Number
- Firm Fax Number
  
  Country CodeArea CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 4) Firm
- Contact
  
  First NameLast Name
- Account Number
- Firm Phone Number
  
  Country CodeArea CodePhone Number
- Firm Fax Number
  
  Country CodeArea CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 3 DEUTZ CORPORATION TERMS AND CONDITIONS OF SALE
- Please read through DEUTZ Corporation's Terms and Conditions of Sales and let us know if there is need for discussion. If so, please download document, make notes and attach to Credit Application.
- Do you agree to DEUTZ Corporation Terms and Conditions of Sale
- Choosing "Continue w/o DEUTZ Corporation Terms and Conditions of Sale" will delay processing of Credit Application.
  
  Please provide DEUTZ Corporation's Legal Department with your concerns:
  
  legal.usa@deutz.com
- 4 DEUTZ CORPORATION Service Dealer Agreement
- Please read through DEUTZ Corporation's Service Dealer Agreement and let us know if there is need for discussion. If so, please download document, make notes and attach to Credit Application.
- Do you agree to DEUTZ Corporation Service Dealer Agreement
- Choosing "Continue w/o DEUTZ Corporation Service Dealer Agreement" will delay start of business.
  
  Please provide DEUTZ Corporation's Legal Department with your concerns:
  
  legal.usa@deutz.com
- Please give us brief feedback on why the Service Dealer Agreement cannot be accepted
- 5 Additional Information
- Additional Supportive Documentation
  
  Browse Files
  
  Cancelof
- Additional Comments
- 6 SIGNATURE OF OWNER / PRINCIPAL OR AUTHORIZED OFFICER / PARTNER
- NOTICE: Applicant and each other person signing below warrants that the information provided herein or in connection with this application is true and correct and authorizes the release of such information to any party who may provide credit to applicant, whether herein or pursuant to a subsequent application or request, to obtain from banks, credit bureaus and other creditors, all of whom are hereby authorized to release any credit / financial information concerning applicant or such other person including such personal credit bureaus reports as said party may deem appropriate, and to share all such information with each other.
- Additional Security Field
- Signature
Should be Empty:

DEUTZ Distributor / Dealer Service Partner Inquiry

DEUTZ Corporation Credit Application

1 General Information

1.1 Business Inquiry Information

1.2 Tax & Purchase Information

1.3 Address Information

2 Financial Section

2.1 General

2.2 Accounts Payable Contact (A/P)

2.3 Bank/Finance References

2.4 Trade References

3 DEUTZ CORPORATION TERMS AND CONDITIONS OF SALE

4 DEUTZ CORPORATION Service Dealer Agreement

5 Additional Information

6 SIGNATURE OF OWNER / PRINCIPAL OR AUTHORIZED OFFICER / PARTNER