Dealer/Credit Application

Thank you for your interest in First Gear and William Britain product lines. If you wish to be considered as a dealer for either or both lines, please complete the following Dealer Application. Completion of this form should precede your initial order so as to allow time for a proper evaluation of your Application.

The information you provide will be kept confidential.

Company Information

Company Name:

Contact Name:

Street Address:

City:

State:

Zip Code:

Country:

Business Phone:

Cell Phone:

Fax:

Website Address:

E-mail Address:

Type of Business:
(Check all that apply)

Store Front  Online (Website)  Auction-Based 
  Other:

Years in Business:

Types of product you currently sell:

What is your annual volume of sales?  

Which product line are you interested in?   First Gear   William Britain   Both  

Credit Line Requested:

Federal Tax ID #:

Has applicant ever filed for relief under Bankruptcy or Receivership? No  Yes

Are there any suits or unsatisfied judgments against Applicant? No  Yes

 

Owners/Partners/Principals

Name

Title

Telephone

 

Bank References

Bank Name:

Address:

Account Number(s) and Type of Account:

Contact Name:

Phone:

Fax:

Financial Statement Available?  Will Send  Will Not Send


Bank Name:

Address:

Account Number(s) and Type of Account:

Contact Name:

Phone:

Fax:

Financial Statement Available?  Will Send  Will Not Send

 

Trade References

List three trade suppliers from whom you buy on open account.

Company Name:

Street Address:

City:

State:

Zip Code:

Telephone:  

Fax:  


Company Name:

Street Address:

City:

State:

Zip Code:

Telephone:  

Fax:  


Company Name:

Street Address:

City:

State:

Zip Code:

Telephone:  

Fax:  



By completing this form the undersigned Applicant hereby agrees to all Terms and Conditions stated or implied.

Terms and Conditions:
  • 1. On all accounts past due 1½% INTEREST PER MONTH (18% ANNUAL PERCENTAGE RATE) will be charged.
  • 2. Should it be necessary to assign the account balance to a licensed collection agency or attorney for legal action, all subsequent collection charges and legal fees shall be paid by the applicant
  • 3. The undersigned agrees to the terms and conditions herein.
  • 4. The above supplier(s) and/or bank(s) are hereby authorized to release information pertinent to a credit check to First Gear.
  • 5.This application may be reproduced to provide or obtain such authorizations.

Please be assured that all information provided will be held confidential.

Signature:  
Date: February 04, 2012