Patternmaster New Dealer Information Request
Business Contact Information
Business Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Years in Business {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
US Company Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
International Company Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Billing Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
US Billing Contact Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Billing Contact Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
International Billing Contact Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Buyer Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
US Buyer Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Buyer Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
International Buyer Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Business Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Business Shipping Information
Shipping Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Shipping Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Shipping Contact Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Shipping Contact Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Which group? (NBS, Sports Inc, etc) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Other Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Business/Trade References
Reference #1
Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Type of Account {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Reference #2
Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Type of Account {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Reference #3
Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Type of Account {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Agreement
1. All new vendors must place a 10 tube minimum order with payment made by credit card; unless other arrangements have been made in advance.
2. Terms are Net 30
3. All late payments will be charged 1.5% late fee that accrues each month beyond Net 30
4. Claims arising from invoice discrepancies must be made within 7 working days.
5. By signing this agreement you have authorized Patternmaster Chokes, LLC to make inquiries into the Business/Trade References that you have listed.
Signatures
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Name and Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Date Signed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Thank You! We are glad to do business with you!