Application for Credit Account with Exaclair, Inc. - FOR RETAILERS ONLY

Online Application: Please complete and click the submit button.

Printer-Friendly version (PDF)

1. Company Name

2. D.B.A.

3. Resale #

4. Fed Tax ID #

5. Company Billing Address


Billing Street Address

City	State	Zip

Phone Number	Fax Number

6. Company Shipping Address

Click box if same as Billing Address:


Shipping Street Address

City	State	Zip

Phone Number	Fax Number

7. E-mail Address

8. Website (if existent)

9. Store Description

10. Years in Business

11. Business is a:

	Sole Proprietorship
	Partnership
	Corporation

12. Company Owner

13. Authorized Buyers

14. Partners

15. Bank Information


Bank Name

City	State

Branch

16. Method of Payment

	Net 30
	Check
	Credit Card
	COD

17. Trade References (three required, i.e. companies with which your firm has reseller accounts):

Trade Reference #1








Account Number

Telephone	Fax

Trade Reference #2








Account Number

Telephone	Fax

Trade Reference #3








Account Number

Telephone	Fax

Check all that apply:

	Please send me Exaclair's catalogs
	Include my store on the Exaclair web site's "Where to Buy" listing
	Other:

I accept these terms.

I/We hereby accept responsibility for invoices being paid within the stated terms. Should litigation be necessary to collect such invoices, court costs and attorneys' fees will be recovered by the prevailing party. The place of performance of this agreement and related orders shall be considered by the parties hereto to be New York, New York.