Catalog Account Log-in Establish Account About Us Contact Us Drop Shipping Drop Shipping

DEALER APPLICATION AND SALES AGREEMENT (No Internet Accounts)

 
Account Number Date

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.


Click here to download Missouri Sales/Use Tax Exemption Certificate and submit by mail or by fax.
If you prefer, you may download all forms and submit by mail or by fax.



Please select option below that best fits your needs.


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      Discover    Debit Card

Credit Card Number

Expiration Date           
Vcode (3 or 4 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, (print name) 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



Catalog | Account Log-in | Establish Account | About Us | Contact | Email

Dragon Distributing, 503 McCleary Rd., Excelsior Springs, MO 64024 - Phone 816-630-6011

© Copyright 2006-2015, Vogler Enterprises - Dragon Distributing Company, All Rights Reserved
Site Design and Management by Morgansites.com