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New Dealer Account Application Form
Page 2 of 2
REFERENCES:
Complete information will speed up processing of your account.
Do NOT use 800 or 888 numbers
1) Company: |
Name |
__________________________________ |
Address __________________________________ |
| |
Phone # |
( )_____________________________ |
Fax # |
( )_______________________________ |
2) Company: |
Name |
__________________________________ |
Address __________________________________ |
| |
Phone # |
( )_____________________________ |
Fax # |
( )_______________________________ |
3) Company: |
Name |
__________________________________ |
Address _________________________________ |
| |
Phone # |
( )_____________________________ |
Fax # |
( )_______________________________ |
4) Bank: |
Name |
__________________________________ |
Address __________________________________ |
| |
Phone # |
( )_____________________________ |
Fax # |
( )_______________________________ |
AGREEMENT WITH AURORA MARINE INDUSTRIES INC.
In consideration of AURORA MARINE allowing us to purchase goods and services on credit, we agree
to the following:
1) We will pay invoices from you per terms and conditions on the invoice.
2) We will pay a monthly service charge on all overdue accounts.
3) Payments will apply first to service charges and then to the balance.
4) Ownership of any goods sold on credit shall remain with AURORA MARINE until paid in full.
5) We consent to your making a credit investigation and/or obtaining credit reports.
Applicant
Signature: |
________________________________________ |
Guarantee
Signature: |
________________________________________ |
Name:
(Please Print) |
________________________________________ |
Name:
(Please Print) |
_____________________________/__________ |
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Authorized signature |
Person responsible for payment (This constitutes a guarantee
by the person signing to pay for any unpaid balance on this account) |
| Title: |
________________________________________ |
Financial Statement Attached: [ ] (Will speed up processing of account)
Application will not be processed unless both Applicant Signature and Guarantee Signature appear above.
____________________________________________________________________________________________________
(FOR OFFICE USE ONLY)
Date: ____________________________________________
Limit: ____________________________________________
Manager’s Approval: _______________________________
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Type of Account: ___________________________________
Sales Representative: ________________________________
Rejected by: _______________________________________
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