Exacompta Planners, Agendas, Journals and Portfolios

Please complete the new customer application below, or complete the PDF version and fax or email it to us. Once approved, you can order immediately using a credit card. To establish terms please allow up to two weeks upon submission of a qualifying order.

If you have any questions or need assistance, please call 1-646-473-1754, Ext. 110, or send us an email.

Please visit Exaclair’s Photo Archive to see all of our products. Organized by brand, www.ExaclairRetailers.com includes product images, interactive catalogs, and more.

Company Name

D.B.A.

Resale #

Fed Tax ID #

Buyer's Email Address *

Billing Address

Billing Street Address

City

State

Zip

Phone Number *

Fax Number

Account Payable Email Address

Shipping Address

Shipping Street Address

City

State

Zip

Phone Number

Fax Number

Shipping & Receiving Email Address

Do you have a "Brick and Mortar" Retail Location?

Yes No

If yes, how many "Brick and Mortar" Retail Locations do you have?

1 2 - 3 4+

Retail Location

Click box if same as Shipping Address:

Retail Location Address

City

State

Zip

Phone Number *

Fax Number

Website

Do you sell online?

Yes No

Do you sell on Amazon or eBay?

What is your storefront name?

Store Description

Years in Business

Business is a:

Sole Proprietorship Partnership Corporation

Company Owner

Authorized Buyers

Partners

Method of Payment

Net 30 Credit Card

How did you hear of Exaclair?

Web
Trade Show
Other Retailers
My customers requested your products
Other (please explain):

What Exaclair brands or products most interest you?

In order to be eligible for terms, please complete the following:

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

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.

Open a Retail Account