Top Notch Distributors, Inc.

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Customer Application

Legal Name of Business

Billing Address

Address

City

State

Zip

Business Phone

Fax

Shipping Address

Address

City

State

Zip Code

Customer Information

# Years Under Present Management

Years at Present Location

Sic Code

Owner of Company

President of Company

AP Contact

Name

Phone

Fax

If you would like your invoices sent to an email or fax different from your AP Contact, please fill out one of these fields:

Invoice Email

Invoice Fax

PO Contact
Same as AP Contact?

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                                            Name
                                        
                                            Email
                                        
                                            phone
                                            
                                            Phone
                                        
                                            Fax

Other Business Info

State Resale Number

Are Purchase Orders Required?

Type Of Ownership

Payment Type

Credit Limit Requested

Name Other Businesses Affiliated With

Federal Employee ID #

Estimated Annual Sales

Description(s) Of Products To Be Purchased (more than one can be selected)

Commercial Bank Reference

Bank Name

# Account Number

State

Zip

Business Phone

Fax

Contact Person

Commercial Trade References
Trade references that have extended the highest amount of credit in the last 12 months

                                            1
                                            
                                            Trade Reference
                                        
                                            Email Address
                                        
                                            Account Number
                                        
                                            Phone Number
                                        
                                            Fax Number
                                        
                                            2
                                            
                                            Trade Reference
                                        
                                            Email Address
                                        
                                            Account Number
                                        
                                            Phone Number
                                        
                                            Fax Number
                                        
                                            3
                                            
                                            Trade Reference
                                        
                                            Email Address
                                        
                                            Account Number
                                        
                                            Phone Number
                                        
                                            Fax Number
                                        
                                            4
                                            
                                            Trade Reference
                                        
                                            Email Address
                                        
                                            Account Number
                                        
                                            Phone Number
                                        
                                            Fax Number

General Comments

Comments or Notes

Verify and Submit Application

Statement of Terms

Applicant authorizes Top Notch Distributors, Inc. to obtain credit reports to be used in connection with this application and to obtain further credit information from any persons or firm set forth in this application and from any other source, including credit profiles on individuals responsible for payment. Applicant further authorizes any bank or commercial business with whom the applicant is doing, or has done any type of business, to give any and all necessary information to Top Notch Distributors, Inc. which will assist in the credit inquiry.

Personal Guarantee

In consideration of credit being extended by Top Notch Distributors, Inc for merchandise to be purchased whether an individual or individuals, a proprietorship, a partnership, a corporation or other entity, the undersigned guarantor(s) hereby contract and guarantee to Top Notch Distributors, Inc the faithful payment, when due, of all accounts said applicate for purchases made. Payment shall be personally guaranteed irrespective of status or changes in existing business of which the undersigned is a principal (owner, partner or officer). Applicant agrees that in the event of default in any payment, to pay all costs of collections, including but limited to, attorney’s fees, court cost, and collection agency fees. Applicant certifies all information furnished is true and accurate, and will be relied upon in the granting of credit.

Requestor Email

Job Title

Authorized Signature (Owner, Partner, or Corporate Officer)

I swear or affirm that the information on this form is true and accurate as to every material matter.

Customer Application

Billing Address

Shipping Address

Customer Information

AP Contact

PO Contact Same as AP Contact?

Other Business Info

Commercial Bank Reference

Commercial Trade References

General Comments

Verify and Submit Application

Top Notch Distributors

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PO Contact
Same as AP Contact?