New Dealer Application

The information below will be kept confidential and is requested solely as a basis to begin business with Daron Worldwide Trading, Inc. Please include this application with your initial order, and fill out the resale certificate on the back of this application.

Allow 72 hours for new credit approval.
Minimum opening order $150.
Prepayment is required without credit approval.

Business Information

Date
Business Name
Billing Address
City
State
Zip
Phone
Fax
Email
Year Business Began
Type of Business
Monthly Sales
Business Entity

Who authorizes payment?
Phone
Customer Contact (Buyer)
Phone

We certify that the above information is correct. All invoices are due in full according to terms. In the event of any legal or collections actions, we agree to pay costs for collection past due amounts including attorney fees and court losses. (Typing your name indicates a legal agreement)

Signature

Bank Information

Bank
Address
Phone
Fax
Account Number
Officer (Contact)

Trade References

Will you be applying for credit?
We authorize credit information
Supplier Name 1
Supplier Account 1
Supplier Phone 1
Supplier Fax 1
Supplier City 1
Supplier State 1
Supplier Zip 1
Supplier Name 2
Supplier Account 2
Supplier Phone 2
Supplier Fax 2
Supplier City 2
Supplier State 2
Supplier Zip 2
Supplier Name 3
Supplier Account 3
Supplier Phone 3
Supplier Fax 3
Supplier City 3
Supplier State 3
Supplier Zip 3
Supplier Name 4
Supplier Account 4
Supplier Phone 4
Supplier Fax 4
Supplier City 4
Supplier State 4
Supplier Zip 4
Supplier Name 5
Supplier Account 5
Supplier Phone 5
Supplier Fax 5
Supplier City 5
Supplier State 5
Supplier Zip 5

Resale Certificate

I hereby certify,

Permit Number
Business Selling

That the tangible personal property described herein which I shall purchase from; Daron Worldwide Trading, Inc. will be resold by me in the form of tangible personal property; provided, however, that in the event any such property is used for any purpose other than retention, demostration, or display while holding it for sale in the regular course of business, it is understood that I am required by the sales and use tax law to report and pay tax, measured by the purchase price of such property.

Property Purchased
Resale Date
Resale Signature
Resale At
Resale Title