Distributor Application

Distributor Application

Memoria Press | 4603 Poplar Level Rd. | Louisville Ky | 40213 | 877 862 1097
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 will be glad to set up a dealer account for you. Simply fill out the form below, and 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 subiting 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 Name Last Name
E-mail *
Phone Number *

- Area Code Phone Number
Website
Business Type *

Bookstore Catalog Online Sales Distributor

Shipping Address *

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

Bank Reference
Bank Name *
Account Number *
City *
State *
Zip *
Phone Number *

- Area Code Phone Number
Account Officer

First Name Last Name
Credit Reference
Company Name *

Address *

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

Phone Number *

- Area Code Phone Number
Fax *

- Area Code Phone Number
Please upload a copy of your resale certificate
Please upload a copy of your W-9
Terms and Conditions
- 40% discount off retail price of 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
- 60-day, no-questions-asked return policy
- 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
I understand the stated terms and conditions *

Yes
Credit Payment Authorization
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 Name Last Name

Billing Address *

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

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.
Credit Card Number – Section 1 (only first four digits) *
Credit Card Number – Section 2 (ONLY the remaining digits) *
Expiration Date *
Security Code *
Electronic Signature *

Clear
Date *

- Month - Day Year
Should be Empty:

Distributor Application

Credit Application

Bank Reference

Credit Reference

Terms and Conditions

Credit Payment Authorization

Credit Card