Application - Heavy Truck Solutions

First & Last Name *

Job Title *

Company Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country *

Country

Phone *

Email *

Website / URL (Must include http://)

What Is Your Primary Business?

Number of Years In Business?

Number of Storefronts?

Yearly Sales Volume?

Reseller Type? *

Interested in a Line of Credit? *

Bank Name *

Account # *

Routing # *

Bank Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Tax Identification Number: Federal Tax ID (EIN)/Social Security Number(SSN)/Canadian Business Number (BN) *

Sales Tax ID/Reseller Permit/Canadian GST/HST Number *

We need this in order to allow you to buy products tax free. We will verify that your permit number is valid and not expired.

Excise Tax Account ID

This is required if your business resides in Washington.

Sales Exemption/Resale Certificate

Click or drag files to this area to upload. You can upload up to 2 files.

If your business resides in the following states, online verification is not available and you will need to upload your Sales Exemption/Resale Certificate: Indiana, Iowa, Kentucky, Michigan, Minnesota, Missouri, Montana, Nebraska, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia, West Virginia, and Wyoming.

D‑U‑N‑S Number

A/P Phone *

A/P Contact *

A/P Email *

Agree to Terms *

I acknowledge and agree to the following terms.

Please read carefully the following terms of service. This is a contract between Heavy Truck Solutions LLC (“HTS” or “We” or “Our” or “Us”) and you. You acknowledge that you have read and understood these terms. Further, if you access www.heavytrucksolutions.com (the “Site” or “Website”), submit a purchase order and/or request an invoice, you accept and agree to be legally bound by these terms.

By signing below, you:

1. Agree to our wholesale terms and conditions as stated on our website here.

2. Authorize us to obtain credit reports or other credit information in connection with this account. We may periodically obtain and review your credit information without notice to you for as long as the account is open and we may use that information to change the terms or rates of the account or terminate the account, or to help collect any amounts under this account, or for any other permitted purpose under applicable law.

3. Agree to pay all amounts due on your account on or before the due date on your invoice. You agree to pay us the entire balance of your invoice, plus any payment past due, any late and/or interest charges, if applicable.

4. Agree to pay an upfront, one-time flat fee of $15 + a 4% monthly finance charge on all past due invoices. We may periodically change these rates and will notify you on your next invoice of such changes.

Electronic Signature of Authorized Owner, Partner or Corporate Officer *

Your signature indicates that you have read, understand, and agree with the terms stated above.

Job Title

Date *

WHOLESALE APPLICATION

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