Rotary Dealer Application

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Business Information

Submitted By*

Business Name*

Business Owner's Name*

Your E-Mail Address*Verify Your Email*

Business Phone #*

Business Fax #

Date Business was Established*

Business Mailing Address

Street Address*

City*

State*

County*

Zip*

Shipping address is the same as mailing address

Business Shipping Address

Street Address

City

State

County

Zip

Credit Application

Required only if "Open Account" was selected above

Owner's Name*

Owner's Home Address*

City*

State*

Zip*

Home Telephone #*

Is there a Second Owner?

Second Owner's Name

Home Address

City

State

Zip

Home Telephone #

Credit References

Please list 3 Credit References and 1 bank reference.
(All four are REQUIRED in full)

Credit Reference (1) Name*

Account #

Contact*

Street Address*

City*

State*

Zip*

Telephone #*

Fax Number

Credit Reference (2) Name*

Account #

Contact*

Street Address*

City*

State*

Zip*

Telephone #*

Fax Number

Credit Reference (3) Name*

Account #

Contact*

Street Address*

City*

State*

Zip*

Telephone #*

Fax Number

Bank Reference Name*

Contact*

Street Address*

City*

State*

Zip*

Telephone #*

Fax Number*

LEGAL AGREEMENT:

Rotary's standard terms are Net 30 days.
If the account becomes past due, applicant agrees to pay interest at the rate of 1.5% per month, calculated on the amount past due.
If the account is placed for collection, the applicant agrees to pay any collection cost incurred to collect the amount outstanding, including reasonable attorney's fees.
Applicant also acknowledges if these fees are not paid, future orders may be refused.
Applicant acknowledges that any balance due to Rotary Corporation for merchandise received from Rotary is the applicant's responsibility, even if the business is sold, unless there is a written agreement between applicant and Rotary stating otherwise.
By the signature of the applicant (officer, principal, owner or partner), you hereby authorize Rotary Corporation to run a full investigation of your credit history including, but not limited to, obtaining a customer credit report.

Owner's Signature*

Date: 04/26/2019

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