New Customer Application

You may need the below documentation to complete this application:

1. Sales Tax Exemption / Resale Certificate

a. Your state may or may not require this documentation. If you are unsure if you require one or need assistance obtaining one, please visit: https://www.tax-id-bureau.com/resale-certificate-sales-tax-exemption/

b. If your state is one that only requires submission after ‘x’ dollar amount, we highly recommend going ahead and submitting this document.

c. While a Resale Permit does have the correct number on the document, it cannot be used as a replacement for the Certificate.

d. If a resale certificate is not submitted, we will charge tax until a form is turned in and Processed by Propét. We will not be able to go back and correct any orders submitted prior to submission.

2. Credit Card Authorization form

a. This form is only needed if you are paying via credit card. If you need a copy of this form, please reach out to your rep or go to: https://acrobat.adobe.com/id/urn:aaid:sc:VA6C2:85cd86c7-e180-47f7-b1d4-2608ec21a9a3.

b. If a form is not returned, we will send a token link once your account is ready to be set up.

3. W9

a. We cannot open an account without this document.

You can save this form to complete later, to do this, please follow the below instructions.

I have read how to save this document

Customer Details:

Propét Representative*

For an up to date rep list by location please visit: https://propetfootwear.com/reps

Prospect number (if available)

Business Legal Name:*

Business Name

DBA/Trade Name(s)

DBA

Date Established:*

Date

RetailMedical

YesNoI would like to know more about the PedRx Program

Type of Medical Service:*

FEIN Number*

FEIN Number

Is your business Sales Tax Exempt or Taxable?*

**Note, some states do not have a Sales Tax Exemption Certificate or only require one after certain amount of sales. If you require one after a certain amount of sales, you should still input your certificate.

How to know if you're Tax Exempt?

Sales Tax Exemption/Resale Number(s) (this is not your EIN number):*

Sales Tax Exemption/Resale #

File Upload - Exemption/Resale Certificate If a valid Exemption/Resale Cert is not uploaded account will be charged Sales Tax. ***Please note, a sales permit is not the same as the certificate and cannot be accepted.*

Exemption/Resale Cert ***Please note, a sales permit is not the same as the certificate and cannot be accepted

Owner/Primary Contact:*

Primary First NamePrimary Last Name

Owner/Primary Phone Number*

Primary Phone NumberFormat: (000) 000-0000.

Owner/Primary Email*

example@example.com

I agree that the information provided above is the same for the buyer

Buyer Contact*

Buyer First NameBuyer Last Name

Buyer Phone Number*

Buyer Phone NumberFormat: (000) 000-0000.

Buyer Email*

example@example.com

What Email would you like to use within NuOrder for purchasing?

example@example.com

I agree that the information provided above is the same as the above

AP Contact*

AP First NameAP Last Name

AP Phone Number*

AP Phone NumberFormat: (000) 000-0000.

AP Email*

example@example.com

Y - Emailed to AP ContactN - USPS Mailed

YesNo

By Signing Below I agree that I will notify Propét and complete an Online Selling Agreement before Selling Online in the future. *

New Customer Application

Online Seller Application