PC DIRECT INC

BUSINESS PARTNER APPLICATION

 

NAME/ADDRESS Account No.______________

Do not fill in account manager will notify you of your new number.

Last: __________________First: __________________Middle Initial: ___Title: __________

Name of Business: _____________________________Tax I.D.#__________________

Address: ___________________________________City: _________________State: _____

Zip: ____________Telephone: ___________________Fax: _____________________

COMPANY INFORMATION

Type of Business: ______________________In Business Since: _________  D&B# _____________________

Legal Form Under Which Business Operates: Corporation: ___Partnership: ___

Proprietorship: ___If Division/Subsidiary, Name of Parent Company: ___________________In Business Since: _________

Name of Company Principal Responsible for Business Transactions: _______________Title: ________Address: _________________________________________

City: _______________State: _____Zip: __________Phone: ________________List Buyers Name: _________________Location: ________________Title: ________Phone: ____________________Ext: ______

If you have more than 1 location and more than 1 buyer please list all information on a second page.

BANK REFERENCES

Bank Name: _____________________________Checking Account No: _______________________

Savings Account No: ______________________Loan Balance: __________Address: _________________________________City: _______________

Zip: ___________Phone: __________________Fax: __________________Account Manager: ___________________

TRADE REFERENCES

Company Name: ____________________________Contact Name: ____________________

Phone: ___________________Account Opened: _____________High Credit: ____________

Current Balance: _______________

Company Name: _____________________________Contact Name: _____________________

Phone: __________________Account Opened: _____________High Credit: ____________

Current Balance: _______________

Company Name: _____________________________Contact Name: __________________

Phone: __________________Account Opened: _____________High Credit: ____________

Current Balance: _______________

PAGE 2

 

 

Please check which level you are applying for.

Level 1: ____ Level 2: ____ Level 3: ____

 

NET TERMS ARE NOT GIVEN TO ANY ACCOUNT UNTIL A 90-DAY EVALUATION PERIOD HAS BEEN MEET. THEN A BUSINESS ACCOUNT MANAGER WILL CONTACT YOU WITH YOUR NEW TERMS IF ANY.

 

STATEMENT OF ACCURACY AND PERMISSION TO VERIFY

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 credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. This joint application covers the PC Direct Business Partner Program and credit terms processes and your evaluation will be automatically viewed in 90 days under the fair credit law act. By signing below you agree to the application and to the policy of the PC Direct Business Partner Program and to the commit of which level you apply for which this application and agreement is covered under North Carolina Law, for PC Direct, Inc.

 

 

PRINT AUTHORIZED SIGNATURE : __________________________________________ DATE : ____________

_______________________________           _______________           ____________

SIGN AUTHORIZED SIGNATURE                       TITLE                          DATE

 

 

 

PLEASE MAKE COPY AND FAX BACK TO (831)604-9361

OR MAIL TO: PC DIRECT, INC.

6325-9 FALLS OF NEUSE ROAD

SUITE 109

RALEIGH, NC 27615

IF YOU HAVE ANY QUESTIONS PLEASE

CALL US AT (919) 848 - 6181