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Dealer Application

Thank you for your interest in becoming a dealer for our mobility products.

Submit Your Dealer Application

Thank you for your interest in becoming a dealer for our various lines of mobility products. We’ve designed this application process to ensure you have all the resources and support you need. By partnering with us, you’ll gain access to a range of high-quality mobility solutions, along with the tools and information necessary to help your customers find the right products for their needs.

Dealer Application

Applicant Information

First

I/We are interested in these products – Please check all that apply

Checkboxes
We are Interested in being a stocking dealer:
Are you a corporation?

Names Titles and Addresses of your corporate officers:

Address (Officer 1)
Address (Officer 1)
City
State/Province
Zip/Postal
Country
Address (Officer 2)
Address (Officer 2)
City
State/Province
Zip/Postal
Country
Address (Officer 3)
Address (Officer 3)
City
State/Province
Zip/Postal
Country

Name and Address of your resident Agent :

Resident Agent Address
Resident Agent Address
City
State/Province
Zip/Postal
Country
Are you a parntership?

Names and Addresses of the partners:

Partner 1 Address
Partner 1 Address
City
State/Province
Zip/Postal
Country
Partner 2 Address
Partner 2 Address
City
State/Province
Zip/Postal
Country
Are you a sole proprietorship?
Are you sales tax exempt?
Have you ever had credit with us before?

Purchasing Contacts

Purchase Order Required?
Purchasing Address
Purchasing Address
City
State/Province
Zip/Postal
Country

Trade References

Trade Reference Address 1
Trade Reference Address 1
City
State/Province
Zip/Postal
Country
Trade Reference Address 2
Trade Reference Address 2
City
State/Province
Zip/Postal
Country
Trade Reference Address 3
Trade Reference Address 3
City
State/Province
Zip/Postal
Country

Bank Reference

Bank Address
Bank Address
City
State/Province
Zip/Postal
Country
I represent that the above information is true and is given to induce 49 Bespoke Inc. to extend dealer status to the applicant. My company and I authorize 49 Bespoke Inc., to make such credit investigation as necessary including contacting the above trade references, banks, and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to 49 Bespoke Inc., all information concerning our financial and credit history.

I have read and agree to the terms and conditions herein and Province all information disclosed is true.

GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE

  1. Invoices are sent by e-mail or faxed, and the product will arrive with a packing slip.
  2. All Invoices not paid within 30 days are considered past due.
  3. A service charge of 1.5% per month will be added to all amounts owing.
  4. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.
  5. PERSONAL GUARANTEE: If the credit customer is a corporation, then those signing this application, whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the corporation.