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Official Authorized Reseller Application
Section 1.)
Business name: ______________________________E-Mail_____________________ Web Address____________________________
Address: _____________________________________ City: _________________________ Province:_________ Postal Code_____________________
How many years in business under this name?_______________________ Contact Person(s):________________________________________
Phone (___________) _________-_____________ Ext__________ Fax (__________) ____________-________________
Vendor Permit Number (Ontario Only) ______________________________________________________________________________
Please Attach PST exemption form
Federal Business Number________________________________________________________________________________________
Terms requested: Wire transfer / Prepayment ( ) COD Cashiers Check ( ) COD Company Check ( ) Company Check ( )
NOTE: Section 1 is required to be filled out completely for all companies requesting payment by wire transfer or COD Cashiers check. All Sections 1, 2, and 3 as well as the authorization to release
information page are required to be completely filled out for all companies seeking approval for COD Company Check or Company Check terms.
---------------------------------------------------------------------------Business Structure-------------------------------------------------------------------------------
Nature of business: Reseller ( ) Distributor ( ) Manufacturer/OEM ( ) System Integrator ( ) Other ( )__________________
President: ____________________________________________________ Phone:__________-_______________ Ext_____________
Annual sales volume: $____________________________________ Estimated monthly purchases: $____________________________
--------------------------------------------------------------------------Trade References-----------------------------------------------------------------------------------
1.) Company name:_____________________________Acct #_________________________ Phone: ____________-_______________
Fax number: ____________-____________________ Contact Person: ____________________________________________________
2.) Company name:_____________________________Acct #_________________________ Phone: ____________-_______________
Fax number: ____________-____________________ Contact Person: ____________________________________________________
3.) Company name:_____________________________Acct #_________________________ Phone: ____________-_______________
Fax number: ____________-____________________ Contact Person: ____________________________________________________
OCZ Canada has a small banner to let resellers know they are buying direct from an official OCZ Canada distributor. Are you willing to place the small banner on your homepage? Y ( ) N( )
*To complete this application it is required that you fax a copy of:
1.) Original tax exemption certification 2.) Copy of a voided company check.
Section 2.)----------------------------------------------------------(NOTE: Required for customers requesting terms or company check only.)-----------------------------------------------------------------------------------------------
Customer agrees to pay OCZ Canada Inc in full amounts due according to OCZ Canada's invoice. Customer also agrees to pay interest @ 1.5% per
month or the maximum provided by law (whichever is less) for invoice amounts that are past due. Should customer default in any such payments, OCZ
Canada Inc. shall have the right, without notice of Customer, to declare all invoice amounts due and payable. In the event OCZ Canada Inc. should
commence any action or actions, or otherwise seek to enforce this agreement against customer or any guarantor, customer agrees to pay reasonable
attorney fees, court costs, and any other expenses incurred by OCZ Canada Inc., whether or not suit is filed. This agreement is not transferable or
assignable without the prior consent of OCZ Canada Inc. This agreement shall become effective upon acceptance by OCZ Canada Inc.
X _______________________________________ _______________________ Date: _______/_______/________
Signature Title
Section 3.)------------------------------------------------------- (NOTE: Required for customers requesting terms or company check only.)-----------------------------------------------------------------------------------------
Individual Personal Guarantee
I, ________________________________________residing at ____________________________________________________ for and in consideration
(Full name) (Home address)
of your extending credit at my request to _____________________________________________ (referred to as "Company') hereby personally guarantee
the payment of OCZ Canada Inc. of any obligation of the company and I hereby agree to bind myself to pay you on demand any sum which may become
due to you by the company whenever the company shall fail to pay the same. It is understood that this guarantee shall be continuing and irrevocable
guarantee and indemnity for such indebtedness of the company. I do hereby waive notice of default, non-payment, and notice hereof and consent to any
modification of renewal of the credit agreement hereby guaranteed.
X______________________________________ _______/_______/_______ X___________________________________ _______/_______/________
Guarantor Date: Witness Date:
X______________________________________ X____________________________________
Print name Print name
( Please fax the completed form to OCZ Canada Inc. 905-479-8551 )
Please print and fill out one authorization for each bank you use..
Authorization to Release Information
*Privacy Act Release
We are currently in the process of establishing trade credit with OCZ Canada Inc. We therefore acknowledge the current privacy act and therefore
authorize you to release all necessary information as requested below in regards to all account (s) and/or credit information. This release remains valid for
the life of my business relationship with OCZ Canada Inc. Please provide the requested information directly to OCZ Canada Inc. regardless of any passed
Privacy Acts. Please reply via fax in order to further expedite my credit application.
------------------------------------------Customer to fill out this portion--------------------------------------------------------------
Business Name:____________________________________________________________________________
Name of Bank: ____________________________Bank Contact Person: _______________________________
Bank phone: (_____) _______-___________Ext:________ Bank Fax: (_____) _______-__________________
Checking account number: ________________________ Loan/Other account number:____________________
X_____________________ ______________________ ____________________ _______/______/________
Account authorized signature Printed Name Title Date
You are now finished with the customer portion of this document.
Please fax back to us at 905-479-8551. We will complete the application and get back to you shortly.
Make Sure to attach a copy of a voided company check when you fax this form
(No customers to fill out below this line)
-------------------------------------------Bank Use Only Below This Line-------------------------------------------------------------
Checking Account:
Checking account number_________________________________ Date Opened:________/_______/_______
*Average balance for last 6 months: $____________ Any NSF checks? Y( ) N ( ) How many_________________
*Average balance for last 30 days: $____________ Any NSF checks? Y( ) N ( ) How many_________________
Other Account: 2nd Checking ( ) Savings ( ) Other ( ) Explain:_________________________________________
Account number_________________________________________ Date Opened: _______/_______/________
*Average balance for last 6 months: $___________ Any NSF checks? Y( ) N( ) How many___________________
*Average balance for last 30 days: $____________ Any NSF checks? Y ( ) N ( ) How many___________________
Loan Account:
Loan account number______________________________________ Date Opened: __________/___________/___________
*Original Loan amount: $________________________ Outstanding loan amount: $_________________________________
*Does loan history show any payments over 30 days late within the last 6 months? Y ( ) N ( ) How many________________________
Comments:____________________________________________________________________________________________________
X_________________________________ _____________________________ ________________________ _______/______/_____
Authorized Bank Personnel Signature Printed Name Title Date
( Please fax the completed form to OCZ Canada Inc. 905-479-8551 )