Instructions: Please type in the appropriate information in the boxes and then print. Please be sure to sign where signatures are requested. Use the "Tab" key to move between the fields. Fax, mail or bring in the completed application to the appropriate office. Be sure to include a copy of your Business License and/or Resale Tax License. This is a requirement. If you wish to use your Credit Card for payment, please also click on the "C.C. Use Application" button and fill out that form. 

After Completing the Application, Please Click Here   To  This Application!

Company Information

Business Name:
Billing Address:
City: State: Zip:
Shipping Address:
City: State: Zip:
Telephone: Fax: Cell #:
Web Site Address:
Email Address:
Sole Proprietorship Partnership Corporation Individual Date Started:
Type of Business: Federal ID #:  
Tax Exempt Yes No                 COD Account? YesNo
State Tax #: Amount of Credit Requested?:

How did you hear about us?

Owners - Officers

Name: Title: SSN:
Home Add.: City: State: Zip:
Name: Title: SSN:
Home Add.: City: State: Zip:
Name: Title: SSN:
Home Add:. City: State: Zip:

Bank Information

Bank Name:  
Checking Acct. #: Savings Acct. #:
Contact: Phone: Fax:
Branch Address: City: State: Zip:

Trade References

Company: Acct. #: Phone:
Company: Acct. #: Phone:
Company: Acct. #: Phone:
Company: Acct. #: Phone:
 

Terms and Conditions

All Invoices are due, in full, thirty days after invoice date. Interest shall be charged at a rate of 1 ½ % per month on past due amounts. In the event payment is not made, purchaser agrees to pay all costs and expenses of collection, including interest and reasonable attorneys fees. Terms and conditions may be changed only by written consent from Mountain West Distributors.

I/We understand, acknowledge, and accept the terms of sale as stated, and certify that the information provided is true and correct.

I/We authorize Mountain West Distributors or your agent to secure a credit report and agree to the release of credit information. This authorization shall be continuing , without expiration. A photocopy or facsimile of this document with its accompanying signature shall carry with it the same force and effect as the original.

Name: Title:

Signature: ________________________________________________ Date:

______________________________________________________________________________________

INTERNAL USE ONLY

Mountain West Salesman-_______________________________________________________________________________

 

 Mountain West Distributors Shipping, Receiving and Warranty Policy

• Customer is responsible for all freight charges for unaccepted or refused shipments.
   
• All shipping, billing and/or pricing errors must be reported within seven days of receipt of shipment, including missing boxes or parts.
   
• Refused shipments or returned merchandise is subject to a 20% restocking fee.
   
• All damaged shipments must be noted as such to the carrier and refused. Product that is not noted as damaged to the carrier and refused will not be replaced by Mountain West Distributors.
   
• The sale of close out and special order items is final.
   
• Mountain West Distributors does not authorize the sale of its products via the internet. All internet sales must be approved through Mountain West Distributors prior to them being listed on a web page.
   
• All defective products will be handled per manufacturer's warranty. Note that it  is the dealers responsibility to inquire about the warranty procedure for a product before purchasing it.
   
• No returns will be accepted without an R. A. Number clearly posted on the outside of the box. All returns must be shipped prepaid freight. Mountain West Distributors will pay the freight for the return of the product to our dealers.
   
• Some manufacturers may require a separate dealer agreement in order to sell their products.

Name: ________________________________________________ Title: ___________________

Signature: _____________________________________________ Date: ___________________

 

Personal and Continuing Guarantee

In Consideration of credit being extended by Mountain West Distributors, Inc. to the aforementioned applicant for merchandise to be purchased, whether applicant be an individual, a proprietorship, a corporation, or other entity, the undersigned Guarantor hereby  unconditionally and irrevocably guarantees the payment and performance of all of applicant's obligations including, without limitation, the payment of all invoices and all accounts for purchases of said applicant. This guarantee is a continuing one and shall therefore remain in full force and effect for all purchases made by the applicant from the date hereof. This guarantee is a guarantee of payment and performance and not of collection. Guarantor hereby waives notice of acceptance of this guarantee and all other notices in connection herewith or in connection with the liabilities, obligations and duties guaranteed hereby, including notices to it of default in payment by the applicant, and Guarantor hereby waives diligence, presentment, protest and suit on the part of Mountain West Distributors, Inc. in the enforcement of any liability, obligation or duty guaranteed hereby. Guarantor further agrees that Mountain West Distributors, Inc. shall not be first or concurrently required to enforce against applicant or any other person or entity, any liability, obligation or duty guaranteed hereby before seeking enforcement thereof against Guarantor.

The liability of the Guarantor shall not be affected or exonerated by the insolvency, bankruptcy, or reorganization of applicant nor by the sale or other disposition of applicant's assets. This guarantee may not be modified or amended without the prior written consent of Mountain West Distributors, Inc. The Guarantor and Mountain West Distributors, Inc. agree that the growing law for any rights, issues or disputes arising hereunder shall solely be the law in the State of Utah, and venue shall exclusively lie in Salt Lake City, Utah. To the extent permitted by applicable law, the undersigned Guarantor hereby expressly waives the right to trial by jury, the right to interpose any defense based upon any Statue of Limitations, any claim of laches, any set-off counterclaim of any nature of description in any action or proceeding instituted against the undersigned Guarantor or any other person or entity hereunder.

___________________________________________________
Individual Guarantor

SWORN TO AND SUBSCRIBED before me, the undersigned authority, this _______ day of ______________________,  _________ by _______________________________________ , who personally appeared and produced as identification his/her ___________________________________.