INVOICE NO:
ACCOUNT APPLICATION
( Please note: incomplete application will not be processed )
|COMPANY INFORMATION |
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|Company Name: _____________________________________________________________________ |
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|Billing Address: ______________________________________________________________________ |
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|Shipping Address: _____________________________________________________________________ |
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|Company website: _______________________ Primary e-mail contact: _______________________ |
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|Telephone Number: ______________________ Fax Number: _______________________________ |
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|( Proprietorship ( Partnership ( Corporation, date incorporated _____ / _____ / ______ |
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|Name of Parent Company if a subsidiary __________________________________________________ |
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|Tax ID Number: ________________________ Resale Number: _____________________________ |
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|Description of Business: _______________________________ Number of Employee (s) __________ |
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|Annual Sales $: _________________________ D & B # ___________________________________ |
|RESPONSIBLE COMPANY PRINCIPALS FOR BUSINESS TRANSACTIONS |
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|Name of owner: __________________________ Title: ________________________________ |
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|Address: ___________________________________________________________________________ |
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|Telephone Number: ______________________ Social Security Number: ________________ |
|BANK INFORMATION |
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|Bank Name: ________________________________ Contact Name: _______________________ |
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|Bank Address: _______________________________________________________________________ |
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|Bank Telephone Number: _____________________ Bank Fax Number: ____________________ |
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|Type of Account: Checking / Saving / Loan / Other Account Number: ____________________ |
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|Type of Account: Checking / Saving / Loan / Other Account Number: ____________________ |
ACCOUNT APPLICATION - continued
|TRADE REFERENCES |
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|(1) Company Name: ______________________ Contact Person: ___________________________ |
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|Address: ___________________________________________________________________________ |
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|Telephone Number: ______________________ Fax Number: _____________________________ |
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|Payment Term: _________________________ Credit Limit USD$: ________________________ |
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|(2) Company Name: ______________________ Contact Person: ___________________________ |
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|Address: ___________________________________________________________________________ |
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|Telephone Number: ______________________ Fax Number: _____________________________ |
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|Payment Term: _________________________ Credit Limit USD$: ________________________ |
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|(3) Company Name: ______________________ Contact Person: ___________________________ |
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|Address: ___________________________________________________________________________ |
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|Telephone Number: ______________________ Fax Number: _____________________________ |
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|Payment Term: _________________________ Credit Limit USD$: ________________________ |
|COMPANY CONTACTS |
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|President: ______________________________ Telephone/Extension Number: _______________ |
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|Purchasing: ____________________________ Telephone/Extension Number: _______________ |
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|Accounts Payable: _______________________ Telephone/Extension Number: _______________ |
I hereby certify that all statements made herein are true and accurate to the best of my knowledge. We authorize SILVERSTONE TECHNOLOGY, INC. to make all inquiries necessary in processing this application for credit. We hereby indemnify SILVERSTONE TECHNOLOGY, INC. and its agent from any and all liabilities resulting from their credit survey. In consideration of credit by SILVERSTONE TECHNOLOGY, INC. to us, we agree to promptly pay all invoices in accordance with the term expressed on the invoice. We agree that SILVERSTONE TECHNOLOGY, INC. will retain a purchase money security interest in all merchandise purchased by us until the payment has been received by SILVERSTONE TECHNOLOGY, INC. We further agree that if the merchandise ordered by us, or any other person designated by us, shall remain unpaid past the invoice due date, any balance so remaining unpaid shall bear interest at the lesser of the rate of 1 1/2( per month or the maximum rate permitted by applicable law, until paid. In the event that any suit or action is instituted to collect amount due on our account, whether principle or interest or both, we agree to pay, in addition to the amount owed, all legal fees and collection agency fees incurred, including a reasonable sum for attorney’s fees.
Signature: ________________________________________ Date: ___________
FINANCIAL RELEASE AUTHORIZATION
Dear Customer,
In order for your bank to release necessary information to us, please complete this form with your signature and return it back to us as soon as possible.
Thank you,
Sincerely,
Pearl Chang
Accounting Manager
Company Name: _________________________________________________________
Company Address: _______________________________________________________
Company Phone: _____________________ Company Fax: ____________________
Bank Name: ___________________________ Bank Officer Name: ______________
Bank Phone: _________________________ Bank Fax: _______________________
(1) Account Number: __________________ (2) Account Number: ______________
Your company authorized signature: ____________________ Title: ______________
• Please attach one copy of voided company check and State Reseller Permit. *
FOR BANK USE ONLY
Date Account Established: _____________( Checking ) ________________ ( Saving )
Average Balance ( Current Month ): _________________________________________
Average Balance ( Last Quarter ): ___________________________________________
Returned Check(s): No / Yes, if yes, how many: _____ Total Amount USD$ ________
Additional Information:
Signature: ____________________ Title: _______________ Date: ____________
SALES AND USE TAX EXEMPTION CERTIFICATE
( Please Print or Type)
FIRM NAME: ___________________________________________________________
STREET ADDRESS: _____________________________________________________
CITY: ______________________________ STATE: ____________ ZIP: _________
PHONE: ___________________________ FAX: _____________________________
I HEREBY CERTIFY:
That I hold valid Seller’s Permit No. _________________________________________
Issue pursuant to the Sales and Use Tax Law, that I am engaged in the business of selling:
That the tangible personal property described herein which I shall purchase from SILVERSTONE TECHNOLOGY, INC. will be resold by me in the form of tangible personal property, PROVIDED, however, that in the event any of such property is used for any purpose other than retention, demonstration, 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 for the tax, measured by the purchase price of such property. This is to continue in force until revoked in writing.
Description of property to be purchased: Computer hardware and accessories including but not limited to computer cases, CPU coolers, hard drive coolers, power supplies, cables, thermal compound kits and etc.
Dated: ___________________________ By Title: __________________________
Signature: ________________________ Print Name: _______________________
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