The following statement to be submitted is made by the applicant for the purpose of obtaining merchandise
from Dragon Distributing on credit, and Dragon Distributing should rely on all information as correct. Applicant
authorizes Dragon Distributing to contact any references given and inquire of them about credit history. Upon
the approval of this application, applicant agrees to abide by the terms and conditions of sale. Applicant further
agrees to notify Dragon Distributing within five days of any changes of ownership, address, telephone, authorized
purchasing agent(s), banks, transfer of listed assets, or other facts set forth below.
Please read Dealer Qualification and Terms before submitting.
If you are applying for an Open Account you will also need to fill out the Application for Credit Privileges.
Click here to submit your Order Form.
Please select option below that best fits your needs.
Bank of America - Direct Deposit
COD -
Customer Check Acceptable on Delivery -
list two references and full bank info (see below)
OPEN ACCOUNT (Submit Application for Credit Privileges)
CREDIT CARD:
Visa
MC
AMEX
Debit Card
Credit Card Number
Expiration Date
Vcode
(3 digit number on back of card)
Name on Card
Statement Address
City
State
Zip
Phone Number
Signature of
Card Holder
(Cannot be typed
or printed)
GENERAL INFORMATION
Legal Name of Firm
Phone Number
Bill To Address
Fax
City
State
Zip
Ship
To Address
City
State
Zip
Type of Business
E-Mail Address
At Present Location Since (Date)
Year Business Opened
Corporation
Partnership
Sole Prop.
Warehouse
Store Front
Other
Pres. (Owner/Partner)
VP
Treasurer
Secretary
A.P. Mgr.
Tax Resale #
State
BANK REFERENCE
Must be completed, signed and be a business account in the business name.
Name of Bank
Bank Account No.
Address
City
State
Zip
Bank Contact
Phone Number
ACCOUNT HOLDER SOCIAL SECURITY NO.Date of Birth
Bank Credit Line: Secured
Yes
No Personal Guaranty
Yes
No
I,
authorize my bank to release any necessary information to
Dragon Distributing for their confidential use in processing my application for check approval.
Signature
Title
Date
APPLICATION FOR CREDIT PRIVILEGES
NOTE: in order to be checked for credit, a $500 order must accompany this dealer application, or a
cumulative total of $500 must have
been purchased in the last 60 days.
TRADE REFERENCES: (Your credit limit with trade references should be at least as high as you
are requesting from Dragon
Distributing). A minimum of four (4) references are required.
Reference 1:
Name
Address
City
State
Zip
Phone
Reference 2:
Name
Address
City
State
Zip
Phone
Reference 3:
Name
Address
City
State
Zip
Phone
Reference 4:
Name
Address
City
State
Zip
Phone
CREDIT REQUIREMENTS -
IMPORTANT: PLEASE ANSWER THE FOLLOWING QUESTIONS
Credit Amount Requested $
Your Authorizing Purchasing Agent
Would you be willing to sign a Personal Guaranty: Yes
No
IF YOU REQUEST A CREDIT LINE LARGER THAN $3,500
PLEASE SEND A CURRENT FINANCIAL STATEMENT.
The undersigned hereby certifies that above information is true and current, and in addition to the foregoing,
the undersigned
promises to pay for all purchases in accordance with Dragon Distributing's terms of sale
If at any time the undersigned is
unable to pay for said purchases when due, the undersigned agrees to pay,
and authorizes Dragon Distributing to bill my
account with interest computed at 2% per month (24% annum)
on any past due amount or the maximum prevailing rate
allowable under the law of state governing the
transactions contemplated by this credit application. If it becomes necessary
for Dragon Distributing to incur
collection costs for any amount due under this agreement, the undersigned promises to pay
additional
collection costs including reasonable attorney fees. Upon acceptance by Dragon Distributing, this application
will
constitute a sales and purchase agreement.
Electronic or Facsimile transmission of signature shall be enforceable against party signing.
Signature (Owner, Officer or Authorized Agent)
Company (Legal Name)
Simply
fill out application on-line, print out,
sign and fax to (816)630-0968 or
(816)630-9440
