Retailer Application

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Thanks for taking the time to apply to partner with us. Please know we value your trust and will not share your information with any third parties or vendors. This is a secure form, and uses the same level of encryption used for online banking. Your data is safe with us!

Have you been in contact with a BN3TH Sales Rep?

Yes No

BN3TH Sales Rep*

First Name

Last Name

How did you hear about us?*

How would you best identify your business channel?*

Legal Business Name*

Date Business Commenced

Operating Trade Name*

Applicable Tax Id#*

Resale Certificate Number*

Upload Resale Certificate*

No File Chosen

File uploads may not work on some mobile devices.

If you have a Resale Certificate document, please upload here.

If you do not have a Resale Certificate because your state do not require, please check the box below:

I do not require to have a certificate

Member of a Buying Group?*

Yes No

Buying Group Name

Contacts

Buyer*

First Name

Last Name

Email*

Phone*

Different Owner / Principal?

Yes No

Owner / Principal*

First Name

Last Name

Email*

Phone*

Different accounts payable contact?

Yes No

Accounts Payable Contact*

First Name

Last Name

Email*

Phone*

Different shipping / receiving contact?

Yes No

Shipping / Receiving Contact*

First Name

Last Name

Email*

Phone*

Billing/Shipping Information

Billing Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Same Billing & Shipping Info

Yes No

Shipping Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Warranty

I have read and agreed to the BN3TH Warranty Policy*

Yes

BN3TH Warranty Policy

MAP & E-Commerce Policies

I have read and agreed to the BN3TH MAP Policy*

Yes

BN3TH MAP Policy

At the moment we are not authorizing any new retailers to sell on any 3rd Party Marketplace. (Amazon, Ebay, Walmart etc.) I understand that I am not authorized to sell on any 3rd party marketplace and that any breach of this agreement will result in the immediate termination of my account with BN3TH.

Yes

Only authorized re-sellers who have been given written permission may list BN3TH products on their website/ e-commerce store. I have read this and agree to only sell BN3TH products in our brick and mortar retail location(s) unless authorized by BN3TH HQ

Yes

I have read and agree to the BN3TH E-Commerce Policy*

Yes

BN3TH E-Commerce Policy

Payment

Select Payment Preference*

Credit Card Net 30 Terms Other

Select Preferred Payment Method*

Credit Card EFT or Wire Transfer Cheque

Terms Requested*

Full Name on Credit Card*

Credit Card*

Terms

This credit card will be considered valid and kept on file to process your outstanding invoices. This credit card can be used for payment on accounts with credit terms or where payment is required before shipping. Our processing system requires all this information in order to complete the transaction.

Credit Amount Requested* $

File

No File Chosen

File uploads may not work on some mobile devices.

If you have a Credit References document, please upload here.

Credit References

1. Company Name*

Contact Name*

Email*

Phone*

Fax

2. Company Name*

Contact Name*

Email*

Phone*

Fax

3. Company Name*

Contact Name*

Email*

Phone*

Fax

Reason

Special credit terms will be reviewed on a case by case basis. Making a request is no guarantee of approval.

I/We hereby authorize Pakage Apparel lnc. dba BN3TH to obtain necessary credit information through the references provided and/or registered reporting agencies, to establish the credibility and financial responsibility of my/our Company and its officer, and guarantee payment in accordance with the terms of sale.

We hereby jointly and severally agree to pay your account (if opened) according to your terms of sale and to pay interest at the rate of 2% per month (24% per annum) on all amounts in arrears.

We understand the terms and agree to abide by them.

By checking this box, you are providing us with a digital signature.*

I Agree

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