Hidden fields Company Representative * Name of person filling in the form Your K&N Sales Rep * Company Details Estimated Monthly Volume With Us * Taxable Status * —Please choose an option—TaxableNon-Taxable Limited Sales Tax Permit # * Name of Firm * Business Classification * —Please choose an option—LLCCorporation (S or C)Sole ProprietorshipIndependent / Other Years in Business * Address * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Phone * Email for Invoicing and Monthly Statements * Fax Business Ownership Owner or Financially Liable Individual * Owner or Financially Liable Individual's Home Address * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Phone * Social Security # * Secondary Owner or Financially Liable Individual Person to Contact about Accounts Payable * Email * Phone * PROCEED TO REFERENCESBank References Name of Bank * City * Account # * Person to Contact * Their Email Address * Their Phone Number * Trade References Reference Company 1 * Person to Contact * Their Email Address * Their Phone Number * Reference Company 2 * Person to Contact * Their Email Address * Their Phone Number * Reference Company 3 * Person to Contact * Their Email Address * Their Phone Number * I accept the following terms and conditions I (We) understand that the information furnished to you in this form is for the purpose of obtaining credit from your firm. That I am (we are) authorized to bind my (our) firm accordingly. That all accounts or monies due to you shall be due and payable at your place of business in Houston, Harris County, Texas. That all past due accounts, notes or judgements shall automatically draw interest at the rate of ten percent (10%) per annum. Accounts not paid by 10th day of the month next following date of shipment will be deemed past due. Venue on any suit to collect a past due account shall be in Harris County, Texas. Nothing in this agreement shall be construed as requiring or allowing the charging of an interest rate greater than that allowed by law in the State of Texas. I (We) understand that the information furnished you on this page is for the purpose of obtaining credit from your firm, and that I am (we are) authorized, in my (our) capacity, to jointly and severally, unconditionally guarantee and promise to be held personally liable for all indebtedness accrued under this continuing agreement. That all past due accounts, notes or judgements shall automatically draw interest at the rate of ten percent (10%) annum. In event of repossession of merchandise, the undersigned agrees to pay 25% restocking charge. In the event of default and referral to an attorney or collection agency, I (We) agree to pay rescuable cost and attorney's fees of at least twenty percent (20%). Back
