Partner Application

Company Information
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
Company Principals
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
Accounting Contact Information
Name *

First Name Last Name
E-mail *
Phone Number *
Fax
Sales Contact Information
Name *

First Name Last Name
E-mail *
Phone Number *
Fax
Customer Service Contact Information
Name *

First Name Last Name
E-mail *
Phone Number *
Fax
Payment Information
Payment Type *
Credit Limit Requesting *
Will you supply us with most current financial statement *
Banking Information
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 *
Vendor References

(Please list minimum of 2)
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
Should be Empty:

Company Information

Company Principals

Accounting Contact Information

Sales Contact Information

Customer Service Contact Information

Payment Information

Banking Information

Vendor References