MODMAXRACING.COM WHOLESALE ACCOUNT APPLICATION

QUALIFICATIONS

• Business must be licensed and recognized by their local government (state, county, city...etc.)
• Business must be actively involved in the AUTOMOTIVE industry
• No initial purchase is required, but parts purchased must be for redistribution or resale ONLY
• Business located in the state of Florida must provide a current sales tax certificate or be charged sales tax
• Business MAY be required to provide UP TO THREE of the following:

1. Copy of Business License
2. Copy of Business Card
3. Copy of Yellow Pages Ad or Listing
4. Copy of Print Advertising
5. Copy of Federal Tax ID Certificate
6. Copy of State Sales Tax Resale Certificate
7. (4) Copies of receipts or invoices (billed in company name) from other automotive suppliers

PAYMENTS

• Easy Payment Terms: Pay Online or over the phone with Credit Card or PayPal
• Company Checks may be accepted for Pre-Pay and C.O.D. orders upon approval
• First time orders for NEW customers CANNOT be shipped C.O.D.
• Credit Card orders are accepted using Visa, Master Card, Discover, or American Express

SHIPPING

• We can ship Air or Ground by UPS or Common Carrier
• Customer pays for all shipping costs on all orders unless specified otherwise
• We may ship some or all parts from any order directly from the manufacturer

RETURNS / DEFECTS

• Defective parts will be warranteed directly by the manufacturer, unless otherwise specified
• Returned merchandise must be pre-authorized by one of our representatives
• Returns must be accompanied by a copy of the original invoice
• Returns that are not defective or shipped in error may incur up to a 25% restocking fee
• Returns from wholesale accounts will be credited toward future purchases ONLY. No Refunds.

By filling out and submitting the following application, applicant certifies that all information submitted is correct. Furthermore, applicant has read and understands the above terms of doing business as a wholesale account and agrees fully with terms listed above.

BUSINESS CONTACT INFORMATION

Company Name:
Mailing Street Address:
City: State: Zip:
Country:

Physical / Shipping Street Address:
City: State: Zip:
Country:

Phone: Fax:

Primary Contact Name:
Email Address:
Website Address:

BUSINESS LEGAL INFORMATION

Business Formation: Sole Proprietorship Corporation Partnership Other

Owner/Partner 1 Name:
Home Street Address:
City: State: Zip:
Country:
Home Phone: Cell Phone:

Owner/Partner 2 Name:
Home Street Address:
City: State: Zip:
Country:
Home Phone: Cell Phone:

Federal Tax ID or Owner Social Security Number:
State Sales Tax Exemption Number:

BUSINESS SURVEY

Date Opened (MM/YYYY):
Time at Current Address (YEARS):
Total Square Feet of Business:
Number of Total Employees:
Does the Business have a Yellow Pages Listing? YES NO
If YES to above, what section is it listed under?

Type of Business (Check all that apply):
Internet Sales
Retail Showroom Sales
Mail Order/Phone Sales
Wholesale Sales
Engine Builder
Installation/Repair/Tuning
Export Sales

Market(s) Serviced (Check all that apply):
Drag Racing
Street Performance
Marine
Circle Track
Road Racing
Truck/Offroad
Other, Specify:

YEARLY Sales Volume in Dollars:
Projected MONTLY purchases from ModMax in Dollars:

BUSINESS REFERENCES

Please list the CURRENT companies that you purchase from now. References listed MUST be in the AUTOMOTIVE industry

Company 1 Name:
Mailing Street Address:
City: State: Zip:

Company 2 Name:
Mailing Street Address:
City: State: Zip:

Company 3 Name:
Mailing Street Address:
City: State: Zip:

Company 4 Name:
Mailing Street Address:
City: State: Zip:


Please enter any other notes, information, or questions for the application:


Please enter the following code into the box provided:



Please submit your application and a company representative will be in contact with you shortly after reviewing your paperwork.