BusinessIQ

Account Requested

Credit Limit Requested
$

^*Type of Account Requested

For Open Account / Terms do you prefer email billing?

Email Address for Billing

Current TecNec Account Number (if applicable)

Company Information/General Business Information

^*Business Name

Doing Business As (DBA Name)

^*Tax ID

^*Billing Address

^*City

^*State/ Province

^*Zip/Postal

Country

^*Accounts Payable Contact Name

^*Telephone

^*Email Address

^*Telephone - Work

Legal Structure

SIC Code

NAICS Code

Number of Employees

Year Business Established

^*Application Contact Name

^*Telephone - Work

Telephone - Cell

^*Application Contact Email Address

Mailing Address

Mailing Address2

City

State/ Province

Zip/Postal

Purchasing Contact Name

Purchasing Contact Telephone

Purchasing Contact Email Address

Country

Other Locations

How many other Locations?

Business Operates From?

What Products are you interested in?

Has firm ever been bankrupt?

If past or present bankruptcy, why?

Resale/sales Tax Number

How did you hear about Tecnec?

Type of Business (Choose One)

Primary Industry Served

Please List TWO Manufacturers or Distributors with whom you currently have Open Account Terms.

^*Reference Name

Fax Number

^*Contact Name

^*Phone Number

^*Contact Email

^*Reference Name

Fax Number

^*Contact Name

^*Phone Number

^*Contact Email

Please Provide Banking Information

^*Bank Name

^*Bank Phone Number

Bank Fax Number

Bank Email Address

^*Bank Contact Name

Principal / Guarantor Information

Principal Type

Principal First Name

Principal Middle Name

Principal Last Name

Principal Home Address

City

State/ Province

Zip/Postal

Telephone - Home

Telephone - Work

Telephone - Cell

Principal Email Address

Principal Social Security Number (SSN)

^*Are you willing to Personally Guarantee (Y/N)
Yes No

Personal Guarantee

In consideration for TecNec Distributing extending credit to the business identified below for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual hereby personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to TecNec Distributing by the business identified below whether said sums are due under open account, contract or otherwise. It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as stated in the credit agreement between TecNec Distributing and the business. Tecnec Distributing shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by TecNec Distributing. This guaranty shall continue in force until notice in writing, sent by registered or certified mail, return receipt requested is received by TECNEC Distributing. Said notice shall specify the date on which this guaranty is to be terminated; said date not to be less than seven days after such notice is received. Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination.

PRINT AGREEMENT

^*Signature Of Guarantor

^*Title

^*Date

The Guarantor(s) execute(s) this Guarantee on his or her own personal behalf, and not in any other capacity regardless of how Guarantor may characterize itself and agrees to all Terms and Conditions of this Application in its entirety.

BY SIGNING ABOVE THE INDIVIDUAL IS EXECUTING THIS AUTHORIZATION FOR CREDIT REPORT INDIVIDUALLY FOR THE PURPOSE OF AUTHORIZING TECNEC DISTRIBUTING TO OBTAIN A CONSUMER CREDIT REPORT, FROM TIME TO TIME, ON THE UNDERSIGNED INDIVIDUAL THROUGH CREDIT AND CONSUMER REPORTING AGENCIES OR OTHER SOURCES, IN ORDER TO FURTHER EVALUATE THE CREDITWORTHINESS OF SUCH INDIVIDUAL IN CONNECTION WITH THE CREDIT EVALUATION PROCESS AND THE PROPOSED EXTENSION OF BUSINESS CREDIT TO THE APPLICANT. THE UNDERSIGNED, AS AN INDIVIDUAL, HEREBY KNOWINGLY CONSENTS TO THE USE OF SUCH CREDIT REPORT IN ACCORDANCE WITH THE FEDERAL FAIR CREDIT REPORTING ACT AS CONTAINED IN 15 U.S.C 1681 SEQ. AS AMENDED FROM TIME TO TIME.

Collateral

Collateral Market Value
$

Ownership Stake in Collateral

Attachments

PLEASE INCLUDE SIGNED CERTIFICATE OF RESALE/TAX EXEMPT FORMS IF APPLICABLE. If you have difficulties attaching or uploading files, please email them directly to credit@tecnec.com

Attachment Description

Attachment Location

Note: Accepted file formats include PDF, CSV, TXT and various image files (JPEG, JPG, GIF, BMP, TIFF, TIF, PNG, ICO). File attachments must not exceed 10 MB in combined size.

Terms and Conditions

^*Signature of Applicant

^*Title

^*Date

PRINT AGREEMENT

I agree to the terms and conditions specified above.

User Verification

Please complete the following by entering the value EXACTLY how it appears(case sensitive)

Why do I have to do this?