2020 USA Dealer Terms ApplicationJackie2022-05-02T12:38:49-04:00Please enable JavaScript in your browser to complete this form. – Step 1 of 5Name of Business *Billing AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOwner's Name *FirstLastPurchasing Contact *FirstLastPurchasing Email Address *Accounting Contact *FirstLastAccounting Email Address *Is your shipping address the same as your billing address? *YesNoShipping AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWould you like to receive an invoice via email or by postal service?EmailPostal ServiceInvoice Email AddressNextBusiness ReferencesWe require 3 references for open accountBusiness Reference #1 Company Name *Business Reference #1 Contact Name *FirstLastBusiness Reference #1 AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Reference #1 Phone Number *Business Reference #1 Fax NumberBusiness Reference #1 Email Address *NextBusiness Reference #2 Company Name *Business Reference #2 Contact Name *FirstLastBusiness Reference #2 AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Reference #2 Phone NumberBusiness Reference #2 Fax NumberBusiness Reference #2 Email Address *NextBusiness Reference #3 Company Name *Business Reference #3 Contact Name *FirstLastBusiness Reference #3 AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Reference #3 Phone Number *Business Reference #3 Fax NumberBusiness Reference #3 Email Address *NextAgreement and AuthorizationI agree to Amati's Fine Instruments open account policy *YesIn order to maintain your open account, invoices must be paid in a timely manner. Past due accounts are subject to cancellation of credit without notice and subsequent third party collection. All invoices are due in Cincinnati, Ohio. Invoices are payable by company check, money order, or bank transfer – payable to Amati’s Fine Instruments. Cash is not accepted. Venue for legal matters is Cincinnati, Hamilton county, Ohio.FEDERAL TAX ID#STATE RESALE CERTIFICATE #Signature *Clear SignatureTHE UNDERSIGNED CERTIFIES THE ABOVE INFORMATION TO BE TRUE AND AUTHORIZES A CREDIT CHECK.Printed NameTitleUpload Files Click or drag files to this area to upload. You can upload up to 3 files. Submit