Partner Application

Company Name *

DBA

Company Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Company address same as mailing address

Yes

Mailing Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Account Type *

Sell on 3rd Party Marketplaces *

eBay User Name

Amazon User Name

Buy.com User Name

Jet.com User Name

Walmart User Name

Sears User Name

Other 3rd Party Sites

Please list below all website URL’s associated with your company that you intend to sell/display MTD products. *

Showroom square footage *

Display space available for MTD Vanities *

Other brands currently been displayed *

Other

Upload business license

Title *

Name *

First Name Last Name

E-mail *

Phone Number *

Title

Name

First Name Last Name

E-mail

Phone Number

Title

Name

First Name Last Name

E-mail

Phone Number

Name *

First Name Last Name

E-mail *

Phone Number *

Fax

Name *

First Name Last Name

E-mail *

Phone Number *

Fax

Name *

First Name Last Name

E-mail *

Phone Number *

Fax

Payment Type *

Credit Limit Requesting *

Will you supply us with most current financial statement *

Bank Name *

Contact Name *

Contact Phone *

Contact Fax

Bank Address *

Account Number *

Account Type *

Name on credit card *

First Name Last Name

Billing address associated with credit card *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Fax Number

I hereby state the below listed credit card information given accuracy and voluntarily, therefore authorizing MTD Vanities to process payment for all future invoices. All Transactions are subject to a free of 1.5%.

Card Type *

Credit Card number *

Expiration Date *

Authorization Code *

For Visa, Mastercard & Discover: The code is the 3-digits on the back of the card. For American Express: The code is the 3-digits on the front of the card.

Other *

Company Name

Open Terms

Credit Limit

Open Balance

Account Number

Contact Name

First Name Last Name

E-mail

Phone Number

Fax Number

Company Name

Open Terms

Credit Limit

Open Balance

Account Number

Contact Name

First Name Last Name

E-mail

Fax Number

Phone Number

Company Name

Open Terms

Credit Limit

Open Balance

Account Number

Contact Name

First Name Last Name

E-mail

Phone Number

Fax Number

By summiting this form I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the account and/or credit to be extended. Furthermore, I hereby authorize the financial institutions and references listed in this vendor application to release necessary information to MTD Bath, Inc. in order to verify the information contained herein.

Signature *

Date *

. Month . Day Year

Company Information

Company Principals

Accounting Contact Information

Sales Contact Information

Customer Service Contact Information

Payment Information

Banking Information

Vendor References