classikcrapplication



	CLASSIK SALES NORTHWEST 12054 Lake City Way N.E. - Seattle, WA 98125 Tel 206 363-9201 - Fax 206 362-5854 Dealer Application (pls. print complete and mail to above) Legal name of company:_________________________________ DBA:_______________________________ Mailing Address: ____________________________________________ City, State, Zip: _____________________, _______ ____________ Shipping Address:___________________________________________ City, State, Zip: _____________________, ________ ____________ Phone # (______) ________________ Fax # (______) ______________________ Email ___________________________________ Type of Business ___individual ___partnership ___corporation Years in Business ________ # of employees_______ Retail store front ___yes ___no Sq. footage ______ State tx exempt. # _________________ Federal EIN # ___________________ Names of Owners Name Title or Officers _________________________ ____________________ _________________________ ____________________ _________________________ ____________________ Accounts Payable Name Phone Contact _________________________ (______) _______________ Trade References 1. Name____________________ Account # _______________ Address________________________________________________ Phone (_____) ________________fax (_____) ___________________ Contact ____________________________ 2. Name______________________ Account # ________________ Address __________________________________________________ Phone(_____) _________________fax (_____) __________________ Contact __________________________ 3. Name____________________ Account # _______________________ Address___________________________________________________________ Phone (_____) _________________fax (_____) __________________ Contact _______________________________ Bank Information Name_______________________________ Account #___________________________ Address _____________________________________________________________________ Phone(______) ________________ fax (______) _____________________ Contact_______________________________ Credit Card Type ___visa ___mastercard # _____________________________________ expiration date_____________ Our terms are 5% 20 net 30 upon approval of credit. New dealers visa or mastercard. Accepted returns are subject to a 15% restocking fee. Goods purchased from Classik Sales NW remain the property of Classik Sales NW until paid for in full. I have read and acknowledge the above: Signature/Title ________________________________________