Please use the print feature on the above right to fill out this form. You may then scan and email it to us or mail it.
DEALER APPLICATION FORM
4x4 Empire, LLC DBA - Competition 4x4 118 West 500 South Spanish Fork, UT 84660 801-798-8403 Sales@Comp4x4.com
BUSINESS GENERAL INFORMATION:
Company Legal Name:__________________________________________________________
DBA: __________________________ Phone: (____)________________
Fax: (____)________________
Billing Address:________________________________________________________________
City: _________________________________________ State: _________ Zip: ____________
E-Mail Address: ____________________________ Web Site: _________________________
Shipping Address: check if same as billing address __________________________________________
City: _________________________________________ State: _________ Zip: ____________
Type of Business: Corporation Partnership Sole Proprietorship LLC Other________
Date Business Commenced: _________________Years at Present Location: _____________
Federal Tax ID #: ____________________________ UT Resale #: ______________________
OWNER/OFFICER INFORMATION:
Name: ______________________ Title: ______________ Phone: (____)________________
Address: __________________________________
Name: ______________________ Title: ______________ Phone: (____)________________
Address: __________________________________
Name: ______________________ Title: ______________ Phone: (____)________________
Address: __________________________________
CREDIT TERMS:
Currently Competition 4x4 is only offering NET 30 credit terms to well established dealers who purchase in large quantities.
BUSINESS LICENSE:
In order to show you are an established business that is authorized to legally conduct business in your city or state, we ask that you send a copy of your current business license.
Kindly scan and e-mail a copy of your license as soon as possible. This will only be done at the time of account setup and is not required each year.
Upon the receipt and acceptance by Competition 4x4, this Dealer Application will serve as a binding contract between the Applicant and Competition 4x4. By the submission of this application, the Applicant agrees to the terms and conditions found on the Competition 4x4 website located directly at: http://www.comp4x4.com/dealer-agreement-form.html
SIGNATURE MUST BE EXECUTED IN ORDER TO PROCESS APPLICATION
Signed: _____________________ Owner Date: ________________
Signed: _____________________ Authorized Buyer Date: ________________
Signed: _____________________ Title: _________________ Date: ________________
Once your application is complete, you may submit it via the following methods:
E-Mail to: Dealer@Comp4x4.com
You can use the print option then scan and e-mail the document
You may also request a PDF file for download or a WORD document
Or
Mail to : Competition 4x4
Attn: New Dealer Application
118 W. 500 S.
Spanish Fork, UT 84660
CREDIT CARD AUTHORIZATION FORM
***NOT REQUIRED***
Please print legibly to ensure timely process. Required field with **
Store Name: _______________________________ State: ______________
**Cardholder’s Name: ____________________________________
Master Card VISA American Express Discover
**Card Number: ______- ______- ______- ______ **Expiration Date: _____/_____
**Security Code: __________
(VISA & MC: last three digits printed on the signature panel) (AMEX: printed above the card #)
** Card Issuing Bank Phone No: ( ______ ) _______ - _______
(Phone Number is printed on the back of card)
Billing Address (Where you receive your credit card statement):
**Street: _______________________________________________________________
City: ___________________________ State: ___________ **Zip Code: ___________
Please check here if you would like this authorization to be effective on future orders
Authorization: I authorize Competition 4x4 to charge my card for order(s)/invoice(s). I agree to pay the credit card charge(s) in accordance with the Card Issuer Agreement. I understand that there would be delay of shipment if the card declines or otherwise incurred difficulty during processing. Note: The signer of this statement MUST be the named cardholder.
**Signature: ___________________________ **Date: ______/______/______
***UTAH DEALERS ONLY***
In compliance with sales and use tax laws, it is necessary that we have a signed
Sales Tax Exemption Form on our file as well as a copy of your actual Sales Tax License.
Kindly scan and e-mail a copy of your license as soon as possible. Otherwise, we will charge sales tax on all orders if we do not have a copy of a Seller’s Permit on file.
Thank you for your kind cooperation and prompt response. Kindly e-mail it to:
A current Utah Sales Tax Exemption Form can be found online at: http://tax.utah.gov/forms/current/tc-721.pdf