Wholesale Application


Updated 09/09/2019 

Baseus Accessories, LLC 
4340 Lyman Dr. Hilliard, Ohio 43026
TEL (833) 422-7387
FAX (614) 529-6521

 

LEGAL NAME

PHONE

TRADE STYLE

FAX

BILLING ADDRESS

CITY/STATE/ZIP

STREET ADDRESS

CITY/STATE ZIP

PLEASE CHECK ONE           

 

CONTACT NAMES  

A/P SUPVR

DIRECT TEL

E-MAIL

PURCHASING MGR

DIRECT TEL

E-MAIL

 

BANK REFERENCES

NAME

OFFICER

CITY, STATE

PHONE

ACCTS: 

 

 

NAME

OFFICER

CITY, STATE

PHONE

ACCTS:       

 

 

BUSINESS REFERENCES 

COMPANY NAME

ADDRESS

CITY/STATE/ZIP

PHONE/ FAX/CONTACT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IN CONSIDERATION FOR THE REQUEST FOR THE EXTENSION OF CREDIT, I, ON BEHALF OF MYSELF, AND MY BUSINESS, ACKNOWLEDGE AND AGREE TO THE FOLLOWING: (1) YOUR INVOICES IN ACCORDANCE WITH THE TERMS AND AT THE ADDRESS FIXED BY THE INVOICE; (2) TO PAY INTEREST ON PAST DUE ACCOUNTS AT THE MAXIMUM LEGAL RATE PROVIDED FOR UNDER APPLICABLE LAW; AND (3) TO PAY ATTORNEY FEES AND COSTS RELATED TO COLLECTION. I FURTHER REPRESENT AND WARRANT THAT THE ABOVE INFORMATION AS WELL AS THAT GIVEN ON ANY ATTACHMENTS AND RELATED DOCUMENTS IS TRUE AND THAT IN MY CAPACITY AM AUTHORIZED TO BIND MY BUSINESS ACCORDINGLY. 

I HEREBY AUTHORIZE BASEUS ACCESORIES, LLC TO INVESTIGATE MY CREDIT AND FINANCIAL RESPONSIBILITY AND THAT OF MY BUSINESS IDENTIFIED ABOVE.

DATE: October 20, 2019    PRINTED NAME:    TITLE:

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Signature Certificate
Document name: Wholesale Application
Unique Document ID: 5457b1654834a7eeade2633b2ea5f5636c752be3
Timestamp Audit
September 26, 2019 12:48 pm EDTWholesale Application Uploaded by Sam Haq - shaq@gobaseus.com IP 71.66.199.42