DECAL GRIP / GRUPO MERCARI - OPEN ACCOUNT APPLICATION
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DATE:_________________
COMPANY NAME:_________________________________________________
Corporation____.Partnership____.Propietorship____.
OWNERS/PARTNERS NAME:______________________________________________________
BILL TO:______________________________________________________
ADDRESS:_______________________________________________________
CITY:__________________STATE________________ZIP:______________
COUNTRY:____________________________
PH:____________________________________FAX:______________________________________
EMAIL@:____________________________WWW._______________________________________
CONTACT (QUERIES):______________________ ________PH____________________
ATTN.(BILLING):__________________________________________PH____________________
SHIP TO (IF DIFFERENT ONLY): _________________________________________________________________________________
STATE OF INCORPORATION:__________________
DATE INCORPORATED:_______________________
YEARS IN BUISNESS:_______________________
RESALE CERTIFICATE No.:__________________
FEDERAL TAX No.:_________________________
NATURE OF BUISNESS:_____________________________
IF BRANCH OR DIVISION GIVE NAME OF HOME OFFICE:_____________________________________
BANK ACCOUNTS: (Checking): ACCOUNT #__________________BANK NAME___________________ CONTACT_______________________PH:______________
THREE COMMERCIAL SUPPLIERS:
NAME______________________________CONTACT_______________PH_____________________
NAME______________________________CONTACT_______________PH_____________________
NAME______________________________CONTACT_______________PH_____________________

I (we) understand that the information furnished above is for the purpose of opening an account from your firm and expressly agree to the following terms and conditions. I am (we are) authorized, in my (our) capacity, to bind my (our) firm as set out herein. All accounts or monies due you shall be due and payable at your place of business, or as indicated on your invoice, in accordance with payment terms specified on your invoice to us. All past due accounts, invoices or notes shall draw interest at the maximum contractual legal rate allowed by law.
The above information is true and correct.
I hereby authorize GRUPO MERCARI to contact the above mentioned banks for any necessary banking information to complete this aplication.

Signed this____day of____________, ____.

Signature:____________________________
Print Name:___________________________
Title:________________________________
_______________________________________________
Please complete and return by fax (800.860 6574) and original by mail to:
DECAL GRIP, DECAL GRIP / GRUPO MERCARI
POBOX 025385, STE 10189, MIAMI FL. 33102-5385

We need an original signature for Bank Checks
Please include a copy of yor Resale Certificate.