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Apply for a Filter Distributorship

Wholesaler Retailer End user

Federal ID# (Social Security#)* Sales Tax ID#*

Type of Business Sole Prop. Partnership Corporation

Phone* Fax Dun & Bradstreet# Company Name* Email Address* Web Site Address Contact Name* Business Type* Area You Cover* Years in Business* Approx. Yearly Sales* # of Employees* Amount of Credit Required* Acct Payable Contact* Acct Payable Phone* Acct Payable Fax Comments Mailing Address* Billing Address* Shipping Address* Credit Reference 1
(no credit cards please)
Include Name, Phone, and Fax* Credit Reference 2
(no credit cards please)
Include Name, Phone, and Fax* Credit Reference 3
(no credit cards please)
Included Name, Phone, and Fax* Bank Reference
Include Name, Address, Telephone, Fax,
Account Number, and Bank Officer*

I/We hereby authorize any and all references given by applicant to answer and reveal any and all credit information, history and details about my/our account to FilterMart Corporation.

Applicant's clicking on the apply button attests acceptance of agreement, financial responsibility, the ability and willingness to pay our invoices in accordance with the following terms and conditions. Terms of payment are Net 30 from date of invoice/shipment of product or service. Interest will be charged at the rate of 1.5% per month on all delinquent accounts. Applicant will be responsible for any attorney fees, court costs and post judgment interest, if default litigation occurs. This agreement shall be enforced in accordance with the laws of the state of Tennessee.

The above information is for the purpose of obtaining credit and is warranted to be true. I/we hereby understand that the above terms are subject to FilterMart Corporation approving your application for credit.

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