EmailMe Form - Texton Account Application

C.O.D. Information

Please provide this information to set up a C.O.D. dealer account (no credit terms) with Texton, Inc.

Company Name *

Company Contact Name *

First Last

Contact Email *

Telephone *

### - ### - ####

Fax

### - ### - ####

Company Physical Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Company Billing Address (if different)

Street Address City State / Province / Region Postal / Zip Code Country / Region

Company Tax ID # *

Type of delivery *

Commercial

Residential

End of C.O.D. Information

If you are NOT applying for Net 30 Terms with Texton, please scroll to the end and hit Submit.

Net 30 Term Accounts

To apply for a Net 30 Term account with Texton, Inc. please provide the additional information below. Allow 2-4 weeks for terms to be established.

Are you a corporation?

Yes

No

Years in Business?

Accounts Payable Contact

First Last

Accounts Payable Contact Email

I prefer to receive invoices by

Email

Fax

Regular Mail

Owner's Name

First Last

Owner's Driver License #

Owner's Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Partner's Name

First Last

Partner's Driver License #

Partner's Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Bank Reference

Name of Bank

Bank Phone

### - ### - ####

Bank Fax

### - ### - ####

Bank Address

Street Address City State / Province / Region Postal / Zip Code Country / Region

Checking Account #

Bank Officer Name

First Last

Trade Reference

Hunter Douglas: Acct #

Gulf Coast: Acct #

Lafayette: Acct #

Robert Allen: Acct #

Westgate Fabrics: Acct #

Timber Blinds: Acct #

Springs Window Fashions: Acct #

Seabrook: Acct #

Thybony, Inc.: Acct #

Kast Fabrics: Acct #

Kravet: Acct #

Other Trade Reference

Terms

NET 30 from INVOICE DATE with approved credit. A charge of 1-1/2% per month will be made on all past due accounts. We reserve the right to change an account status from open to COD should the account become delinquent.

It is understood that all bad checks and overdue accounts will be turned over for collection and/or prosecuted. Purchaser agrees to pay all costs of collection including court costs and reasonable attorney's fee in case suit or action is commenced to collect all or part of this account.

Limited Sales Tax Permit Number

Date

MM / DD / YYYY

Company

Your Full Name

First Last

Your Job Title

Tax Resale Certificate

The undersigned holder of the Limited Sales Tax Permit listed above under authority of the Limited Sales, Excise and Use Tax Act, (TEX. TAX. GEN. ANN. art. 20.01 et seq.) claims the right to make a non-taxable purchase for resale of taxable items from:

Supplier's Name

Supplier's City and State

Taxable items purchased will be resold, rented or leased by purchaser within geographical limits of the United States, its territories or possessions in the normal course of business either in the form or condition in which purchased, or as an attachment to, or integral part of other tangible personal property.

Description of items to be purchased

I understand that I will be liable for payment of the Use Tax if I fail to comply with the applicable provisions of the Limited Sales, Excise and Use Tax act and Comptroller Rules regarding purchasing of taxable items for resale.

It is a misdemeanor to give Resale Certificate to teh seller for taxable items which I know at the time of purchase will be used in a manner other than that expressed in this certificate, and upon conviction I understand I may be fined up to $500 per offense.

AN OUT-OF-STATE RETAILER PURCHASING ITEMS FOR RESALE IN HIS HOME STATE MAY VALIDATE THE RESALE CERTIFICATE WITH THIS SALES TAX PERMIT NUMBER OR CERTIFICATE OF AUTHORITY ISSUED BY HIS HOME STATE

Name of Purchaser

First Last

Address (City, State, Zip)

Date

MM / DD / YYYY