WHOLESALE / RETAIL Become a Wholesale / Distributor ...

WHOLESALE / RETAIL

APPLICATION / PAGE 2

WHOLESALE / RETAIL

APPLICATION

Become a Wholesale / Distributor Checklist: 1. Fill out this application 2. Email or Fax W9 3. Email or Fax Resale Tax Exemption Certificate 4. Fax a copy of your credit card, or pay by check or ACH. Talk to your sales rep about payment options.

FAX COMPLETED APPLICATION TO (724) 765-0606 OR EMAIL IT TO SPARTANEPOXIES@ / SUBJECT WHOLE APPLICATION

BUSINESS NAME: MAILING ADDRESS:

DATE:

city

state

zip

SHIPPING ADDRESS:

(IF DIFFERENT THAN MAILING)

city

state

zip

BUSINESS PHONE:

FAX:

BUYERS NAME:

BUYERS EMAIL:

BUYERS PHONE:

BUYERS FAX:

THE FOLLOWING INFORMATION MUST BE COMPLETED (PRINTED OR TYPED) AND WILL BE HELD IN THE STRICTEST CONFIDENCE.

TYPE OF BUSINESS (CHECK MARK):

APPLIANT IS: ___PARTNERSHIP ___ SOLE OWNER ___ CORP. In the State of______

OWNER'S NAME:

OWNER'S NAME:

OWNER'S PHONE:

OWNER'S PHONE:

OWNER'S ADDRESS:

OWNER'S ADDRESS:

city

state

zip

city

state

zip

NUMBER OF YEARS IN BUSINESS:

D&B #:

WE (I) CERTIFY THAT ALL OF THE ABOVE INFORMATION IS CORRECT AND WE HAVE READ AND AGREE TO YOUR TERMS OF SALE, AS WELL AS ALL OTHER INFORMATION ON YOUR POLICY STATEMENT.

DATE:

SIGNED:

TITLE:

GUARANTOR:

SUBSCRIBE TO OUR NEWSLETTER? EMAIL ADDRESS:

WWW.

?COPYRIGHT 2017 SPARTAN EPOXIES LTD

WHOLESALE / RETAIL

APPLICATION / PAGE 2

WHOLESALE / CREDIT

APPLICATION

Become a Wholesale / Distributor Checklist: 1. Fill out this application 2. Email or Fax W9 3. Email or Fax Resale Tax Exemption Certi icate 4. Fax a copy of your credit card, or pay by check or ACH. Talk to your sales rep about payment options.

RESALE TAX EXEMPTION CERTIFICATE

SPARTAN EPOXIES WILL NOT BE SOLD ONLINE. CHECK TO AGREE:

ISSUED TO: ADDRESS:

DATE ISSUED:

STATE:

ZIP:

I CERTIFY THAT:

CITY

NAME OF FIRM STREET ADDRESS

STATE

IS ENGAGED AS A REGISTERED: WHOLESALER

RETAILER

MANUFACTURER

OTHER:

ZIP

Is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases are for wholesale, resale, ingredients or compponents to a new product to be resold, leased or rented in the normal course of business. We are in the business of wholesaling, retailing, manufacturing, retailing, leasing or renting.

PRODUCTS OR SERVICES RENDERED:

STATE: CITY OR STATE: CITY OR STATE:

STATE REGISTRATION OR ID NO: STATE REGISTRATION OR ID NO: STATE REGISTRATION OR ID NO:

I FURTHER CERTIFY THAT IF ANY PROPERTY SO PURCHASED TAX FREE IS USED OR CONSUMEDD BY THE FIRM AS TO MAKE IT SUBJECT TO SALES OR USE TAX WE WILL PAY THE TAX OUT DIRECT TO THE PROPER TAXING AUTHORITY WHEN STATE LAW SO PROVIDES OR INFORM THE SELLER FOR ADDED TAX BILLING. THIS CERTIFICATE SHALLE BE PART OF EACH ORDER WHICH WE HEREAFTER GIVE TO YOU, UNLESS OTHERWISE SPECIFIED, AND SHALL BE VALID UNTIL CANCELLED BY US IN WRITING OR REVOKED BY THE CITY OR STATE.

I SWEAR OR AFFIRM THAT THE INFORMATION ON THIS FORM IS TRUE AND CORRECT AS TO EVERY MATERIAL MATTER.

AUTHORIZED SIGNATURE:

TITLE:

PRINT NAME:

DATE:

WWW.

?COPYRIGHT 2017 SPARTAN EPOXIES LTD

NOTICE TO BUYER

DISCLAIMER OF WARRANTIES AND LIMITATIONS ON OUR LIABILITY

NOTICE TO BUYER: DISCLAIMER OF WARRANTIES AND LIMITATIONS ON OUR LIABILITY

We warrant that our product is manufactured to the specifications as stated her or in other publications. All other information supplied by us is accurate to the best of our knowledge. Such information supplied about our products is not a representation or a warranty. It is supplied on the condition that you shall make your own tests to determine the suitability of our product for your particular purpose. NO WARRANTY IS MADE, EXPRESSED OR IMPLIED, REGARDING SUCH OTHER INFORMATION, THE DATA ON WHICH IT IS BASED, OR THE RESULTS YOU WILL OBTAIN FROM ITS USE. NO WARRANTY IS MADE, EXPRESSED OR IMPLIED, THAT OUR PRODUCT SHALL BE MERCHANTABLE OR THAT OUR PRODUCT SHALL BE FIT FOR ANY PARTICULAR PURPOSE. NO WARRANTY IS MADE THAT THE USE OF SUCH INFORMATION OR OUR PRODUCT WILL NOT INFRINGE UPON ANY PATENT. We shall have no liability for incidental or consequential damages, direct or indirect. Our liability is limited to the net selling price of our product or the replacement of our product, at our option. Acceptance of delivery of our product means that you have accepted the terms of this warranty whether or not purchase orders or other documents state terms that or other documents state terms that vary from this warranty. No representative is authorized to make any representation or warranty or assume any other liability on our behalf with any sale of our products. Any use or application other than recommended herein is the sole responsibility of the user. Uncured epoxy resins, polymers and their curing agents may be ALKALINE, TOXIC or BOTH, depending on the particular system. They may cause ALLERGIC REACTIONS or HYPERSENSITIVITY REACTIONS. BEFORE USING any material, READ THE MATERIAL SAFETY DATA SHEET AND FOLLOW ALL PRECAUTIONS TO PREVENT BODILY HARM. COPYRIGHT 01/12/15 SPARTAN EPOXIES LTD.

WWW.

?COPYRIGHT 2017 SPARTAN EPOXIES LTD

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