Credit Application. parsource.com GENERAL INFORMATION. Internal Use Only: The following documents are required to begin the application process:

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1 The following documents are required to begin the application process: * Missing documentation could result in delays in establishing your account. ncompleted and signed credit application ncompleted Blanket Resale Certificate or copy of Business License or copy of Seller s Permit ncompleted and signed Credit Card Authorization Form (if paying via credit card) GENERAL INFORMATION Type of business (Please check one to expedite process): Commercial Greenhouse Manufacturer Commercial Greenhouse Distributor Retail Garden Center Electrical Contractor/Contractor/Greenhouse Builder Commercial Greenhouse/Nursery Grower/Research Facility Internet Company Hydroponics Store University/School Other (please specify): List type of products sold: Thank you for your interest in becoming a PARsource customer, we look forward to being part of your success! Internal Use Only: Approved By: Customer #: 32- Date Entered: Salesperson #: Terms: Price Level: Credit Limit: Ship Via: No CC Needed (see credit terms) No ACH Needed (see credit terms) Cal Farm Exempt (PARsource code CAAGRI - No Resale Certificate required) Special Notes: Page 1

2 Please be aware that completion of this credit application does not guarantee your acceptance as a PARsource reseller. * All information will be held in the strictest of confidence. Please print clearly. COMPANY INFORMATION Company Name: Parent Company Name (if division or subsidiary): Bill To Information Date Business Started: Resale Certificate #: Do you sell on the internet? yes no Ship To Information Business Classification (please select one) C-Corporation Sub Chapter S Tax ID# Manufacturer Contractor Electrician Grower Retailer Name of Principal(s)/Officer(s) Title Percentage Owned Partnership (if more than 2 partners please include separate sheet with this same information) Tax ID# Owner(s)/Partner(s) Name: Percentage Owned: Home Home Cell Own Rent # of years Owner(s)/Partner(s) Name: Percentage Owned: Home Home Cell Own Rent # of years Sole Proprietorship Tax ID# Owner Name: Home Own Rent # of years Home Cell S. McDowell Ext. Petaluma, CA USA Page 2

3 Please be aware that completion of this credit application does not guarantee your acceptance as a PARsource reseller. * All information will be held in the strictest of confidence. Please print clearly. Accounts Payable COMPANY INFORMATION Join PARsource and GO GREEN! If you would like us to your invoices to the address above, check here Bank Credit Reference Checking Savings Name of Branch: Business Credit References Please list two active references with whom you deal on an open account basis. Name: Name: Name: Have you ever filed bankruptcy? yes no Date: State Filed: Placing Orders Please provide a list of personnel authorized to place orders for your company S. McDowell Ext. Petaluma, CA USA Page 3

4 UNIFORM SALES & USE TAX CERTIFICATE - MULTIJURISDICTION Company Name: Authorized Buyer s Name: Buyer s I certify that the above named buyer is engaged as a registered: Retailer Wholesaler Manufacturer Tax Exempt Agency and is registered with the below listed state within which your firm would deliver purchases to us and that any such purchases are for wholesale, resale, ingredients or components of a new product or service to be resold, leased or rented in the normal course of business. We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following: *Description of Business: General description of tangible property to be purchased from the seller: Indoor/Outdoor Specialty Gardening Equipment/Supplies *State Registration # *State Sales Tax Number # I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax we will pay the tax due directly to the proper taxing authority when state law so provides or informs the seller for added tax billing. This certificate shall be a part of each order we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter. *Authorized Signature: * *Date: *Expiration Date: Page 4

5 CREDIT CARD AUTHORIZATION FORM By signing below, I (we) hereby authorize PARsource to initiate credit or debit entries to my (our) credit card by debiting or crediting the account indicated below, herein after called DEPOSITORY, and to debit or credit the same such account. I (we) agree to pay within our established credit terms with PARsource for all goods ordered from PARsource. I (we) acknowledge that the origination of credit card transactions to my (our) account must comply with the provisions of U.S. law. This authorization is to remain in full force until PARsource has received written notification from me (or my designate) of its termination in such a time as to afford PARsource and DEPOSITORY reasonable opportunity to act. Customer Number: 32- Company Name: Name on Card: Billing City: State: Zip Code: Credit Card Type (please check one) Visa Mastercard Discover Card Number: Expiration Date: Cardholder s Signature: Submit Credit Card Authorization Form to: PARsource Lighting Solutions 2249 S. McDowell Ext. Petaluma, CA Page 5

6 ACH AUTHORIZATION AGREEMENT If you choose ACH as your preferred method of payment it is your responsibility to ensure the funds are available when the invoices are due. Any change requested in terms to an order must be communicated when you place an order. * All information will be held in the strictest of confidence. Please print clearly. ACH is my preferred method of payment (check box) By signing below, I (we) hereby authorize PARsource to initiate credit or debit entries to my (our) Checking/Savings account by debiting or crediting the account indicated on the attached voided check, herein after called DEPOSITORY, and to debit or credit the same such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. This authorization is to remain in full force until PARsource has received written notification from me (or my designate) of its termination in such a time as to afford PARsource and DEPOSITORY reasonable opportunity to act. Customer Number: 32- Company Name: Account Information Checking Savings Name of Financial Institution: Routing Number: Signature Authorized Signature (Primary): Authorized Signature (Joint): Date: Date: You MUST attach a voided CHECK for a CHECKING ACCOUNT or a DEPOSIT SLIP for a SAVINGS ACCOUNT. (You can make a copy of a blank check or deposit slip and write VOID across the copy.) Please return this form and a copy of a voided check or deposit slip to: Accounts Receivable 2249 S. McDowell Ext. Petaluma, CA Page 6

7 TERMS & CONDITIONS nnew accounts must fill out a wholesale customer application form and provide PARsource with their federal Tax ID numbers as well as a completed Resale Card and Personal Guaranty with a business license. A photo of the store may also be required. ncredit is available for established accounts provided proper documentation is received and credit check approved. Please inquire with our Accounts Receivable department. Terms may be removed at any time that PARsource deems necessary. nparsource accepts Visa, MasterCard, and Discover for credit card payments. A completed and signed credit authorization form will be required for this payment option. nparsource is pleased to accept ACH (electronic check) as a payment option. A completed and signed ACH Authorization form is required for this payment option. na $40 fee will be charged for payments returned to PARsource for non-sufficient funds. nany account not paid in pull within your terms will be assessed a service charge of 1.5% or the state maximum allowable fee. nif any invoices are not paid in full by discount due date - no invoices will be eligible for a discount - discount will be reestablished once all invoices are within the discount date. All payments must be remitted to our corporate office: PARsource Lighting Solutions 2249 S. McDowell Ext. Petaluma, CA nall prices are FOB our Distribution Centers unless otherwise noted. ncredit limits requested in excess of $50,000 may require a signed UCC filing for value of PARsource delivered inventory. nfrom time to time during our business relationship, samples of PARsource products or other vendor distributor products may be provided to you at no charge. You may be responsible to report and pay any applicable use tax on these items in accordance with the laws of your state. Deposit nparsource may require a minimum deposit of 25% for all orders ove $10,000 to accounts with established credit. Freight nthe best shipment method will be determined by PARsource. Most orders are shipped via common carrier. PARsource will prepay and add freight charges to invoices. Damages & Shortages nall freight damages and shortages must be noted on the bill of lading at time of delivery. PARsource and the freight carrier are not responsible for damages or shortages not clearly noted on the bill of lading. PARsource requests a copy of the bill of lading with the notes within 24 hours of receipt of your order. Please fax a copy of the bill of lading to PARsource Sales at Drop-ship orders n PARsource is not responsible for damaged or lost drop-shipments. All lost or damaged claims related to drop-shipments must be handled directly with the freight carrier. Any special packaging situations may be subject to additional charges. Page 7

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