A fully completed dealer application is required before credit can be granted. This information is confidential and is requested due to the need to establish standards for recognizing dealers and granting discounts. This information is necessary to protect present dealerships and you as a potential dealer. Please answer the questions as completely as possible. Please return by MAIL and to the address listed above. Thank you. EXACT LEGAL NAME of business ______________________________________________Phone # ____________________ DBA______________________________________________________ e-mail address _________________________________ Business address ______________________________________________________________Fax # ______________________ City ___________________________________________ State_________________________ Zip Code ___________________ BUSINESS CLASSIFICATION: ? Proprietorship
? Corporation (FID #__________________________State________ date filed__________)
? Partnership
? Corp., non-profit (FID# _________________________State __________ date filed________)
? LLC
(FID# ____________________________ State ________________date file_________)
PRINCIPALS (owners, officers, board members): Name _____________________________________ Title ________________________ Home phone# ___________________ Home address _________________________________________ City___________________ State __________ Zip_________ Name _____________________________________ Title ________________________ Home phone# ___________________ Home address _________________________________________ City___________________ State _________ Zip __________ Name _____________________________________Title _______________________ Home phone# ____________________ Home address _________________________________________ City ___________________ State _________ Zip__________ Is this a branch store or under common ownership with another store, church or organization? If yes, please list: Name of entity _________________________________________ Principal owner/officer ______________________________ Address ______________________________________________City __________________State _______ Zip _____________ Manager’s name ____________________________________________ phone # ______________________________________ Are you a member of any of the following associations: ? CBA (Christian Booksellers Association)
?ABA (American Booksellers Association) ? ALA (American Library Association)
? EDSA (Educational Dealers Supply Association) ? NSSA (National Sunday School Association) ? Other _______________ Date business was established _________________________ Do you ? own or ? lease the store property? not necessary unless otherwise informed.)
Date of current ownership ________________________
(Photographs of your store, the inside and/or the outside, are welcome but Page 1 of 3
Is this location zoned business? q yes q no
If no, please explain: ________________________________________________
Is there a store front? q yes q no . . . . . . . . . . . Is there a visible outdoor sign? q yes q no Do you advertise? q yes q no If yes, please list where you advertise: ______________________________________________ Store size: __________ft. X __________ft. (or _______________square feet) Are you open to the public? q yes q no If no, please explain: ___________________________________________________ Do you have a prior account with Standard Publishing? If yes, what is the name and location? ____________________________ Business hours (please circle the days appropriate for the hours marked): M T W TH F S S from _________ to ______________ M T W TH F S S from _________ to ______________ M T W TH F S S from _________ to ______________ Approximate cost of inventory on hand $_______________________ Anticipated monthly sales (average) $_________________ Sales last year $______________________________
Sales two years ago $________________________________
STATE LAW indicates the merchandise purchased for resale is exempt from sales tax. As a vendor, we are required to keep your resale certificate sales tax exemption number on file. Please attach a copy of the certificate. ****** SALES TAX EXEMPTION NUMBER ___________________________________ state ________________ ******* BUSINESS TYPE (please check the description(s) below that best represents your business): q Open to the public as a licensed retail business. Open at least four days a week and regular business hours. Store sign is visible to the public. Maintain and display reasonable inventory levels. Have additional overhead expense such as rent and salaries. q Retail store in a main business district or shopping center. q In home, separate entrance to the store – location is zoned business. q In a church, open to the public as a licensed retail business. Open at least four days a week and during regular business hours. Store sign visible to the public. Separate from the church with a separate entrance. Maintain reasonable inventory levels. Staff in the store during all business hours. Please list exceptions: ______________________________________________________ **Please include photographs of the interior and exterior of your store.** q Church, purchasing merchandise for church functions. q Mail order/direct mail. Produce/distribute at least one major catalog per year…80% of sales volume is generated through catalog. q Chain store; have at least three retail outlets under same ownership. q Racker. No retail outlets. Wholesale marketing plan. q Wholesaler/distributor. No more than 10% of product purchased is sold through your own retail outlet. q Book club. Have at least 10,000 subscribers. Produce at least four different book club brochures a year. q Book fairs… in schools, churches, etc. No retail outlets. q Evangelistic association, Christian broadcasting company or like organization. Distributes materials for financial support of its ministry. Resale. Promotional. q University, college or other institution q Internet sales. Please list web site address: _______________________________________________________________ q Other, please explain ___________________________________________________________________________________ Are you listed in Dun & Bradstreet? q yes q no If yes, please list your DUNS # _____________________________ Have you ever filed bankruptcy? q yes q no If yes, when did you file? ________________ Which chapter? ___________ Banks where accounts are maintained: 1. Name _______________________________ Account # ____________________________ Phone #____________________ Address _____________________________________City ________________________State _________ Zip_______________ 2. Name _______________________________ Account # ____________________________ Phone # ____________________ Address _____________________________________ City _______________________State __________ Zip______________ Page 2 of 3
TODAY . . . Cash on hand in the bank $ _____________________________
Accounts receivable $________________________________
Accounts Payable $ ___________________________________
Notes Payable $ ____________________________________
Outstanding loans are: q secured
q personal guarantee
Other sources of income:
q unsecured
________________________________________________________________________________
Please attach a copy of your latest financial statement. List publishers with whom you have established credit and with whom you continue to do business: Name
phone #
terms
account number
credit limit
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Our terms of sale are generally Net 30 days from date of invoice. Past due balances are subject to 1.5% interest per month or the highest lawful rate allowed. Finance charges will be assessed each month until the past due balance, including finance charges, is paid. A $15.00 fee will be assessed should your check be returned from the bank dishonored. The undersigned is responsible for all collection fees, court costs, and legal fees which may be incurred to collect delinquent balances. ******************************************* To the best of my knowledge, the information provided in the application is complete and accurate. I understand that this information has been provided to you for the purpose of obtaining credit from Standard Publishing and you are authorized to contact our bank and other vendors for credit references for this purpose. I, being authorized in my capacity to bind this business accordingly, agree to the terms and conditions outlined above and will abide by same. __________________________________________________________________________________ Name (please print and sign) _________________________________________ Business Name
_______________________________________ Title
____________________________________________________________________________ Business address City State zip
_______________________ Date *** NOTE: a signature is required before open terms can be granted.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Thank you for taking the time to fill out this application. We look forward to serving you. If you have any questions or concerns, please feel free to contact the Credit Department at 800-543-1301. To help the approval process move faster and more efficiently, please feel free to fax this application to 877-867-5751. We do require the original for our files so be sure to MAIL this from as well. An envelope is provided for your convenience.
Page 3 of 3
33-89056