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:

The undersigned Applicant hereby authorizes all financial institutions, trade or credit references, and whoever may have credit experience to release credit and financial information to First Gear, Inc. in support of this application and for any subsequent review to grant credit. This application may be reproduced to provide or obtain such authorizations. By completing this form the Applicant hereby agrees to all Terms and Conditions stated or implied.

Signature:
Date: August 20, 2008