Dealer Application Form

Business Information

Legal Company Name*

Mailing Address*

Shipping Address*

City*

Province/State*

Postal/ZIP Code*

Email*

Phone*

Fax

GST#

PST#

Fed. ID# or SSN

Courier Account # *

Purchasing/Sales Contact

Accounts Payable Contact

Credit References

Company Name*

Address*

Email*

Phone*

Fax

Company Name*

Address*

Email*

Phone*

Fax

Company Name*

Address*

Email*

Phone*

Fax

Authorization

Applicants Signature Attests financial responsibility, ability and willingness to pay our invoices in accordance with the following terms.

Terms for payment of invoices are Net 30 days from invoice date. Accounts not paid within terms will be charged interest invoiced at 2% per month, 24% per annum. Customer will be responsible for paying collection costs including legal fees (if applicable) in the event of delinquency in payment of account. It is fully understood that all products purchased from Defender Pump guards remain the sole property of Defender Pump Guards until such time payment, including all interest charges, are paid in full. Overdue accounts may be subject to orders being held until the account is in current status. Purchase orders for non-standard products are subject to the same terms and conditions as applied to invoices. It is fully understood that product claims (i.e. warranty, shipping, etc.) are dealt with independently, and will not affect full payment of invoices at regular terms. It is fully understood that Defender Pump Guards does not guarantee fit of product when mounted in conjunction with attachments, or non-standard equipment, not pre-approved by Defender Pump Guards, and resulting claims will not affect full payment of invoices at regular terms. It is fully understood late of non-payment by end-users (i.e. individuals, institutions, government bodies, etc.) will not affect full payment of invoices at regular terms.

Name*

Position*

The above information is for purposes of obtaining credit and is warranted to be true. I/we hereby authorize the company to whom this application is made to investigate the references listed pertaining my/our credit and financial responsibilities.