2020 USA Dealer Terms Application - Amati's Fine Instruments

Name of Business *

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Owner's Name *

First

Last

Purchasing Contact *

First

Last

Purchasing Email Address *

Accounting Contact *

First

Last

Accounting Email Address *

Is your shipping address the same as your billing address? *

Yes
No

Would you like to receive an invoice via email or by postal service?

Email
Postal Service

Business References

We require 3 references for open account

Business Reference #1 Company Name *

Business Reference #1 Contact Name *

First

Last

Business Reference #1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Reference #1 Phone Number *

Business Reference #1 Fax Number

Business Reference #1 Email Address *

Business Reference #2 Company Name *

Business Reference #2 Contact Name *

First

Last

Business Reference #2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Reference #2 Phone Number

Business Reference #2 Fax Number

Business Reference #2 Email Address *

Business Reference #3 Company Name *

Business Reference #3 Contact Name *

First

Last

Business Reference #3 Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Reference #3 Phone Number *

Business Reference #3 Fax Number

Business Reference #3 Email Address *

Agreement and Authorization

I agree to Amati's Fine Instruments open account policy *

Yes

In 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 *

THE UNDERSIGNED CERTIFIES THE ABOVE INFORMATION TO BE TRUE AND AUTHORIZES A CREDIT CHECK.

Printed Name

Title

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