Reseller Application Form

Company Name *

Email *

Billing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Website/URL

Phone

Fax

Type of Business

Year Established

Tax Exempt #

No. of Employees

PLEASE INCLUDE A COPY OF YOUR RESALE CERTIFICATION WITH THIS APPLICATION.

Click or drag a file to this area to upload.

Principal Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

A/P Supervisor

First

Last

Phone

Shipping Notification Email

Primary Contact

First

Last

Phone

Shipping Information

Shipping Address same as Billing Address

Shipping Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Prefered Method of Payment

Dropdown

Profile

Business Type

Internet Sales

Mail Order?

Business References

Company Name

Phone

Fax

Company Name

Phone

Fax

Open account will be provided upon approval of credit application by TELEFUNKEN Elektroakustik. Please allow 30 days for processing.

If a payment made to TELEFUNKEN USA is returned due to insufficient funds, all discounts will be revoked and a $25.00 service charge will be assessed. If it becomes necessary to place an account into collection, any and all collection fees will be the responsibility of the account holder.

TELEFUNKEN USA, LLC reserves the right to re-evaluate credit status and refuse shipment and/or revoke credit approval if any open account terms are violated.

I certify that I am an authorized agent for the institution submitting this applications, and that all of the information contained herein is accurate and true.

I fully understand TELEFUNKEN's credit terms and agree to make proper payments to TELEFUNKEN USA, LLC. I understand that all merchandise purchased from TELEFUNKEN USA, LLC will be exempt from bankruptcy.

Upon approval, this dealership will remain pending for a period of 60 days unless activated with an opening order. Dealership approval is canceled for accounts that are not activated.

Authorized Agent

Title

Date

Comment