Dealer Application

Step 1 of 3

Company Name*
D/B/A*
Years in Business*
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
A/P or Financial Contact*
Phone #*
Fax #
Shipping
- Check this box if Shipping Info is not the same
Shipping Address*
Street Address City State / Province / Region ZIP / Postal Code Country

Contact Name*
Contact Email*
Company Website
Type of Business*
- Corp.
- Sole Prop.
- Partnership
- LLC
- S Corp
- C Corp
Nature of Business*
Annual Revenue*
Should we charge you sales tax?*
- Yes
- No
If no, company must provide us with a copy of its tax exemption certificate.
Federal Tax or Employer ID #*
Licenses*
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 32 MB.
Please attach a copy of your Resale Tax certificate, a completed W-9 form and your current Business State License(s) or Drivers or Import License(s).

Bank Reference
Bank Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Contact Name*
Contact Email*
Contact Phone #*
Contact Fax #
Trade References
Please provide at least three references of other vendors you have used in the last three years for goods and services. We will contact these organizations as a reference of your good standing.
Trade Reference #1
Company Name*
Phone*
Fax
City*
State*
Trade Reference #2
Company Name*
Phone*
Fax
City*
State*
Trade Reference #3
Company Name*
Phone*
Fax
City*
State*
Terms and Conditions - All sales transactions shall be governed by the state of Kansas. Applicant agrees that payment terms are NET 10 DAYS, FOB Shipping Point unless expressly agreed to in writing by Arrow. Past due balances are subject to interest at 1.5% per month (or the maximum permissible rate under applicable law, whichever is less) on the unpaid balance. Applicant will pay any legal fees and third party collection costs incurred by Arrow to collect payment for past due amounts. Applicant agrees to promptly notify Arrow in writing of any change in the ownership of Applicant. Applicant warrants and represents that the information contained herein is accurate and may be relied upon by Arrow in making credit decisions, including increasing, decreasing or terminating any credit availability at any time with Arrow sole discretion. Applicant hereby authorizes Arrow to check its bank(s) and supplier(s) and any other source as necessary to complete the evaluation of Applications' credit history. Applicant acknowledges and agrees that, in the event of any inconsistency between the payment terms hereof and the terms of any purchase order or other document issued by Applicant, the terms hereof will control. Subject to compliance with all applicable laws, Arrow reserves the right to deny credit to Applicant or increase, decrease or terminate Applicant's credit availability at any time and for any reason without notice to applicant.*

800-821-7563

Dealer Application

Step 1 of 3

Bank Reference

Trade References

Trade Reference #1

Trade Reference #2

Trade Reference #3