Wholesale Parts Account Application

"*" indicates required fields

Business Information

Company Name*

Owner Name*

Type of Business*

Website

Business Phone*

Business Fax

Business Address*

Street Address Address Line 2 City State ZIP Code

Type of Business*

e.g., Retail, Repair, etc.

Years in Business*

Federal Tax ID (EIN)*

Tax Status*

Taxable

Non-Taxable

Resale Certificate/Tax Exemption Number*

Mailing Address*

Same

Different

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Owner/Principal Contact Information

Name*

First Last

Email*

Phone*

Address*

Same

Different

Is the owner/principal's address the same or different from the business address?

Address*

Street Address City State / Province / Region ZIP / Postal Code

Payables Contact Information

Name*

First Last

Title*

Phone*

Email*

Address*

Same

Different

Is the payablel's address the same or different from the business address?

Address*

Street Address City State / Province / Region ZIP / Postal Code

Accounts Payable Email*

What email should invoices be sent to?

Purchaser/Direct Contact Information

Name*

First Last

Title*

Phone*

Email*

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