Distributor Application

Distributor Application

Memoria Press | 4607 Poplar Level Rd. #102 | Louisville Ky | 40213 | 502 966 9115
We are continually growing our network of dealers and resellers. If you have a catalog, website, or store and would like to carry Memoria Press products, we invite you to fill out the application below. A representative will contact you with details as soon as possible.

If you would like more information about becoming a distributor of Memoria Press products prior to submitting this form, you can contact us at sales@memoriapress.com. Thank you.
Credit Application
Company Name*
Company FEIN*
If you are international distributor and do not have an FEIN, enter "INTERNATIONAL"
Contact Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Website
Fulfillment channels*

Brick and mortar storeOnlineOther
Business Type*

BookstoreCatalogOnline SalesDistributorOther
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you plan to pay via Invoice or prepay via Credit Card?*

Pay via InvoicePrepay via Credit Card (may be subject to a 3% convenience fee)
Bank Reference
Bank Name*
Account Number*
City*
State*
Zip*
Phone Number*

Area CodePhone Number
Account Officer

First NameLast Name
Credit Reference
Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Fax*

Area CodePhone Number
Please upload a copy of your resale certificate

Upload a File

Cancelof
Please upload a copy of your W-9

Upload a File

Cancelof
Terms and Conditions
- 40% discount off retail price of Memoria Press-published individual products for orders of $100 - $499. 44% for orders of $500 and above.
- Net Payment on all invoices is due within 30 days
- A 1.5% finance charge per month is applied to all overdue invoices
- Memoria Press reserves the right to ship via its standard carriers
- These terms are binding for all orders placed with Memoria Press and may not be changed by a purchase order or customer document not signed by a Memoria Press representative. Shipment of products is not an acceptance or ratification of unsigned documents
- All contracts are interpreted according to Kentucky state law. Gaps in Memoria Press’ terms assume application of the Uniform Commercial Code
- Credit card payments are subject to a 3% convenience charge
- Drop Ship orders will incur a $10 fee
- Promotions and coupons are not applicable with the distributor discount
- Please note that the distributor discount only applies to individual products, not sets. However, we will gladly discount the price of the individual components that we publish
- 60-day, no-questions-asked return policy
I understand the stated terms and conditions*

Yes
I authorize any overdue invoices or balances to be charged to the credit card listed below. This card will not be charged without verbal authorization unless a balance becomes overdue.*

Yes
Name on Card*

First NameLast Name
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Credit Card

For security purposes, and to protect the integrity of your card, please enter only the first four digits in section 1, and enter the remaining digits in section 2. Thank you.
Electronic Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Distributor Application

Credit Application

Bank Reference

Credit Reference

Terms and Conditions

Credit Card