Dealer Application

DEALER APPLICATION FORM

APPLICANT - Please read the following carefully before completing this form. This is a form that we require before granting you dealer status with Music Marketing. This is not necessarily a credit application and credit will not be automatically granted. We require at least 6 months of regular business before credit management would consider granting credit terms.

Applicant represents that the information in this application is complete and accurate and authorizes Music Marketing to check reporting agencies, credit references and other sources disclosed to confirm the information given.

After you submit this application, our customer service department will contact you and once approved you can begin placing orders right away.

INTERNAL Please let us know which of our sales representatives you were dealing with. Sales Rep: BILLING INFORMATION Full Legal name (Company): Bill to Address: City:    State:  -- AB BC MB NB NF NS ON PE PQ SK -- AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    PCode:    Ship to Address: City:    State  -- AB BC MB NB NF NS ON PE PQ SK -- AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    PCode:  Email: Telephone: Fax:   BUSINESS CREDIT INFORMATION   Principal(s) and Title(s): Tax ID Resale #: Account Payable Contact: Acc/Pay Telephone: Type of Company Corporation Partnership Sole Proprietorship   Subsidiary of: Location: Amount of Purchase: Annual Sales:   Year Business Started:   Main Business:   Credit Request:   TRADE REFERENCES   Company 1: Address: City: State: -- AB BC MB NB NF NS ON PE PQ SK -- AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY PCode:   Email: Business Telephone: Business Fax: Contact Name: Company 2: Address: City: State: -- AB BC MB NB NF NS ON PE PQ SK -- AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY PCode:   Email: Business Telephone: Business Fax: Contact Name: Company 3: Address: City: State: -- AB BC MB NB NF NS ON PE PQ SK -- AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY PCode:   Email: Business Telephone: Business Fax: Contact Name: BANK REFERENCES   Bank Name: Bank Contact: Bank Address: City: State: -- AB BC MB NB NF NS ON PE PQ SK -- AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY PCode:   Bank Telephone: Bank Fax: Account No (Chequing): Account No (Savings): I accept and agree to the following terms and conditions with respect to all business transactions with Music Marketing hereafter: 1. INTEREST ON LATE PAYMENTS: Interest at the rate of 10% for invoices not paid within the agreed upon terms. 2. COST OF COLLECTION: All costs incurred by Music Marketing for the collection of this account including, but not limited to, all fees paid to collection agencies and reasonable attorney's fees, whether suit is commenced or not including court costs will be assessed against the undersigned. I accept these terms and conditions