WHOLESALE APPLICATION FORM |
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Please download and complete the following application. You may either mail it to us to: P. O. Box 578832, Modesto, CA 95357; fax it to (209) 571-1029; or e-mail it to sales@JTSilversmiths.com. Please remember to sign the application and enclose a copy of your seller's permit.
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| Business Information | |
| Parent Company or Branch Names: | |
| Number of Locations: | |
| Phone No. | |
| Fax No. | |
| E-mail: | |
| Billing Address | |
| Address: | |
| City, State, Zip Code: | |
| Country: | |
| Shipping Address | |
| Address: | |
| City, State, Zip Code: | |
| Country: | |
| Permits | |
| Years in Business: | |
| Business License No.: | |
| Resale Permit No.: | |
| City: | |
| State: | |
| Type of Business: | ____ Sole Proprietorship | ____ Corporation | ____ Partnership | ____ Other |
| Name of Principles | |
| Name: | |
| Title: | |
| Address: | |
| City, State, Zip Code: | |
| Country: | |
| Bank References | |
| Bank Name: | |
| Address: | |
| City, State, Zip Code: | |
| Country: | |
| Contact: | |
| Phone No.: | |
| Fax No.: | |
| Business Reference (1) | |
| Company Name: | |
| Contact: | |
| Address: | |
| City, State, Zip Code: | |
| Phone No.: | |
| Business Reference (2) | |
| Company Name: | |
| Contact: | |
| Address: | |
| City, State, Zip Code: | |
| Phone No.: | |
I hereby certify that all the above information is accurate to the best of my knowledge, I understand that any verbal trade or order placed by a representative of my company creates a binding contract between JT Silversmiths and my company. In addition, I agree to pay all costs of collection, including reasonable attorney fees and court costs. As principal owner or representative of applicant company, I hereby personally guarantee all debts incurred by said company with JT Silversmiths. The signer below hereby authorize ________(if yes, put initials), _______(no) the above bank to release any necessary information to JT Silversmiths for purposes of credit approval. The under signed purchaser hereby certifies to the seller, JT Silversmiths, that purchaser holds a valid Registration or Sales Tax Permit Number _________________ issued under the Retail Sales Act of the State of ______________; that the tangible property purchased on each order is purchased for the purpose of resale, ___________________ (if other, describe) and will assume all liability for the payment of the Use Tax if applicable to provisions of the Limited Sales, Excise and Use Tax Act and comptroller rules regarding purchasers of taxable items for resale in their state. It is a misdemeanor to give a resale certificate to the seller for taxable items knowing that, at the time of purchase, those items will be used in a manner other than that expressed in the certificate, and upon conviction understand that the undersigned party may be fined $500.00 or more per offense or purchase. |
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Date__________________ |
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