Meyer Distributing
New Customer Application
1.800.MeyerUSA
meyerdistributing.com
Meyer Distributing
IN / Central Offices
560 E. 25th St.
Jasper, IN 47546
THIS APPLICATION IS NOT AN EXTENSION OF TRADE CREDIT / OPEN ACCOUNT.
Do you wish to apply for trade credit / open account? – please request Meyer Distributing Credit Application from your salesperson.
This application is intended for creating a customer account with Meyer Distributing and is not an application for trade credit.
Please fax completed application to Indiana / Central offices at 866.644.9460 or email to CustApps@MeyerDistributing.com.
If Applicant has any questions, please call 1.800.MeyerUSA or email at the above address.
Any missing information will delay processing of application.
Date_____/_____/________Email Address___________________________________Website___________________________________
Business Legal Name________________________________________DBA____________________________________________
Phone(_____)_______________Fax(_____)_______________Check One: Corporation______Partnership_______Proprietorship_______
Number of Employees________In Business Since_____/_____/_______Date of Incorporation (if applicable)______/______/_______
Primary Product Categories__________________________________________________________________________________________
Primary Lines Purchased / Volume____________________________________________________________________________________
Existing Suppliers / $ Volume_________________________________________________________________________________________
Operation Layout (Sq. Footage, Bays, etc.)_____________________________________________________________________________
Mailing Address: Street___________________________________________City, State & Zip____________________________________
Shipping Address: Street__________________________________________City, State & Zip____________________________________
Parent Co. Name (if applicable)_____________________________Partnership Name (if applicable)_________________________________
Mailing Address (if applicable): Street_________________________________City, State & Zip_______________________________
State Tax Exemption #___________________Federal ID #____________________BMV# (required to sell scooters)__________________
Accounts Payables Manager(s)___________________________________Email(s)_____________________________________________
Accounts Payables: Phone(_____)_______________Fax(_____)_______________
Name of Bank_______________________________________Contact(s)______________________________________________________
Bank Account Number(s)____________________________________________________________________________________________
Bank: Mailing Address (Street)______________________________________City, State & Zip____________________________________
Bank: Phone(_____)_______________Fax(_____)_______________Email(s)__________________________________________________
Complete the following for all corporate officers, partners, or an individual proprietor and all authorized check writers.
Name(s) & Title(s)__________________________________________________________________________________________________
Home Address(s)___________________________________________________________________________________________________
City/State/Zip(s)____________________________________________________________________________________________________
SSN#(s) & Date(s) of Birth____________________________________________________________________________________________
The undersigned certifies under penalties of law that the information given in this application is true and correct to the best of his / her
knowledge and personally guarantees all instruments of payment on the above account. Any returned check, NSF or stop payment, will be
subject to a $50.00 administrative fee or 10% of the check amount whichever is greater. The undersigned individual (“Guarantor”) hereby
personally guarantees, unconditionally and irrevocably, the prompt payment of any sums now or hereafter owed to MEYER DISTRIBUTING by
Debtor whether said sums are due under open account, contract or otherwise. This Guaranty shall continue in force until notice in writing,
sent by registered or certified mail, return receipt requested, is received by MEYER DISTRIBUTING. Said notice shall specify the date on
which this Guaranty is to be terminated; said date not to be less than seven (7) days after such notice is received. Such termination shall in
no way release the undersigned as to any sum or debt incurred prior to such termination.
Below may ONLY be completed by the Guarantor (Owner/President/Chairman/Principal) of Business named above and is required for account
activation.
Date____/____/______Guarantor Printed Name____________________________Guarantor Signature_____________________________
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