DEALER APPLICATION

In order to buy wholesale goods from A-a Distributors, interested parties must complete and mail or fax in the following form(s).

Dealer Application Form [756k Adobe Acrobat PDF]

If you prefer, you may fill in the following online form instead and submit your application immediately.

APPLICATION FOR COMPANY CHECK APPROVAL

*Business Name (hereinafter referred to as buyer):

*Billing Address:

City, State, Zip:

Phone:

*e-mail Address:

Web Address:

Type of Business:

Business Start Date:

Contact Name:

Authorized Buyers:

Resale Tax I.D. Number:

OWNERSHIP

Check One:

Sole Proprietorship
Corporation
Partnership

Please give name, home address and phone number of principal officers or owners:

#1

Name:

Title:

Social Security Number:

Home Address:

City, State, Zip:

#2

Name:

Title:

Social Security Number:

Home Address:

City, State, Zip:

#3

Name:

Title:

Social Security Number:

Home Address:

City, State, Zip:

TRADE REFERENCES

*Please list skateboard distributors and manufacturers Only:

Company Name:

Company Name:

Company Name:

Company Name:

BANK REFERENCES

Bank Name:

Branch:

Address:

City, State, Zip:

Phone:

Check All That Apply:

Checking
Savings
Loan

Account Number:

Second Bank Name (if Any):

Branch:

Address:

City, State, Zip:

Phone:

Check All That Apply:

Checking
Savings
Loan

Account Number:

CREDIT CARDS

I hereby authorize A-a Distributors to charge my orders upon the following credit card(s):

Mastercard
Visa

Account No.:

Expiration Date:

V# (last group of numbers):

Do you own Real Estate?

Parcel 1 Address:

City, State, Zip:

Parcel 2 Address:

City, State, Zip:

Owned or Leased Vehicle

Year:

Make:

Model:

Leased
Owned

Lessee or Lender:

Address:

City, State, Zip:

Buyer hereby authorizes Seller to check Buyer's bank and credit references to obtain such information as may be required to approve this application for company check approval. Buyer agrees that this application for company check approval shall remain Seller's property and will be included in Buyer's credit file.

In consideration of the granting of company check approval by Seller to Buyer, it is hereby agreed that the Buyer will pay all sums when due. In event of non-payment, the undersigned does hereby agree to pay in addition to the principal amount due, all collection charges incurred by Seller including NSF charges, charges made by a collection agent up to but not exceeding 30% of the principal balance due, and in the event of suit, reasonable attorney's fees and court costs. The buyer further agrees to pay interest at the rate of 18% per annum commencing on the first day following the due date for any monies owing. In the event of breach of the above contract, the Seller reserves the right to change credit terms.

Company Name:

By:

Title:

PERSONAL GUARANTEE

In consideration of the approval of company check by the Seller , herein to Buyer herein, the undersigned does jointly and severally personally guarantee to pay and be responsible for payment of all sums, balances and accounts due Seller by Buyer, including collection charges and/or attorney's fees. This shall be open and continuing guarantee and shall continue in force notwithstanding and charge in the form of such indebtedness, or renewals or extensions granted by Seller, without obtaining and consent there to, and until expressly revoked by written notice from me/us to Seller. Any such revocation shall not in any manner affect my/our liability as to any indebtedness existing prior there to. I/we do hereby waive notice of the acceptance of this agreement. notice of default or non-payment and waive action required by any statue, against the buyer. No delay on Seller's part in exercising any right hereunder, or taking any action to collect or enforce payment of any obligation hereby guaranteed, either as against the Buyer or any other person primarily or secondarily liable with the Buyer, shall operate as a waiver of any such right or in any manner prejudiced Seller's right against me/us. I/we agree that in the event of any default at any time by said Buyer, Seller shall be entitled to look to me/us immediately for full payment without prior demand or notice.

*Full Name:

*Home Address:

*City, State, Zip:

*Phone:

*Driver's LIcense No.:

*Social Security No.:

*Personal Bank:

*Branch:

*Account No.:

*AN HONEST PERSON GOES FAR...A DISHONEST PERSON GOES NOWHERE*

By submitting this form, you agree to its terms and conditions.