DEALER APPLICATION FROM

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1 18 CROWN STEEL DRIVE, UNIT 114, MARKHAM, ONTARIO L3R 9X8 TEL: (905) FAX: (905) NATIONWIDE TOLL FREE: WORLD WIDE WEB: DEALER APPLICATION FROM How to become a B.S.C. Technologies Inc. Customer? Please read and complete the Dealer Application Form. Insufficient information or documentation may delay your account set up. Your account set up will be ready within 48 hours.. First time orders must be paid by Certified Cheque, Money Order, or Direct Deposit. B.S.C. Technologies will require the following document(s) to process your request: Check List: For All Accounts, the following are required: REQUIREMENTS Fully completed, dated and signed Dealer Application Form. Copy of Vendor s Permit / Business Permit. Copy of Voided Company Cheque (blank, typed, stamped, or hand-written cheque is not accepted). Copy of up to dated Provincial Sales Tax Exemption Certificate (see chart below for requirements). PROVINCE PROVINCIAL REQUIREMENT AB (Albert) Business License / Certificate of Incorporation / Provincial Registration BC (British Columbia) Provincial Sales Tax Exemption Certificate MB (Manitoba) Certificate of Registration NB (New Brunswick) Certificate of Registration NF (Newfoundland) Certificate of Registration NS (Nova Scotia) Certificate of Registration ON (Ontario) Vendor Permit AND Blanket Exemption Certificate Form PE (Prince Edward Island) Certificate of Registration PQ (Quebec) TVQ (Taxe de vented u Quebec) SA Saskatchewan Ministry of Finance License *Please note that all sales must be prepaid or paid by cash or certified cheque. Company cheques are accepted only upon approval by our credit department. However, for any order over $ , must pay by cash or certified cheque. PLEASE FAX COMPLETED FORMS TO Page 1 of 5

2 DEALER APPLICATION FORM FOR OFFICE USE ONLY Sales Rep.: Note: Customer No.: GENERAL INFORMATION Business Legal Name: Business Trade Name: Billing Address: Phone No.: Fax No.: Shipping Address (if different from billing): Prov. / State: Country: Postal code / Zip: Phone No.: Fax No.: BUSINESS TYPE Sole Proprietorship Partnership Corporation Subsidiary Division No. of Employee: No. of Location: In Business Since: Annual Sales Volume: Monthly Purchase: Business Registration No.: PST No.: OFFICERS Owner / Officer: Social Insurance No. Home Address: Account Payable Contact: Phone No.: Extension No.: Purchaser Contact: Phone No.: Extension No.: TRADE REFERENCES (3 references are mandatory) Company Name Contact Phone No. Fax No. Credit Terms BANKING INFORMATION Bank Name: Contact: Billing Address: Phone No.: Fax No.: Page 2 of 5

3 DEALER APPLICATION FORM AGREEMENT I/We consent to the obtaining of bank/credit and/or personal information as may be required at any time in connection with the credit hereby applied for or renewal or extension thereof and to the disclosure of the credit information concerning me/us and/or my/our company to any credit reporting agency or to any person with the undersigned who has or purports to have financial relations. I/We further agree to indemnify BSC Technologies from all claims, which may arise because BSC Technologies disclosed information about myself/us and/or my/our company. I/We further acknowledge having been informed of the Terms and Conditions of Sales as well as the prevailing terms for repayment and agree to pay a service charge, currently 2% per month compounded monthly (26.82% per annum) on any overdue balance until paid. In the event that any action or suit is instituted to collect amount due on our accounts, I/we agree to pay all legal and collection fees in addition to the amount owed plus interest charges. I/We further acknowledge that BSC Technologies reserves the sole discretion and right to decline, change or revoke my/our payment terms at any time on the basis of my/our payment record and/or financial situation, and/or changes to BSC Technologies s credit policy. I/We further acknowledge that payments returned by my/our financial institution for reasons not limited to non-sufficient funds will be subject to an administration fee of CDN $50.00 the said amount may be increased without prior notice. I/We further acknowledge that Title of Goods remains with BSC Technologies even though goods may be in transit and/or on customer s premises (in case of resale), until payment has been received in full. Furthermore, I/we understand that all products are shipped without insurance, unless otherwise specified and shipping losses and damage are my/our responsibility. I/We agree to inform BSC Technologies in writing of any changes in the legal name and form of the Company. Failure to do so will permit BSC Technologies to continue to deal with the undersigned in the form as noted on this application, or with the new entity said which accepts all conditions herein above mentioned. I/We have read and agreed to abide by BSC Technologies s current terms & conditions of sales. I/We hereby certify that the information contained in this application is true and correct. Signature: (President and/or Treasurer) Title: Name: Date: / / (Please Print) (mm/dd/yyyy) Please choose one of the following insurance options, which will be applied to every invoice once received by BSC Technologies. A. You would like to have your shipment insured: Insurance charge for each $100.00CAD of shipment value is $0.60CAD, per package. B.S.C. Technologies Inc. will receive the insurance and declare the value to UPS. UPS will then take the responsibility/liability for any such shipments. All claims regarding insured shipments will be based on UPS s policy and UPS reserves the right to make the final decision of all related issues. B.S.C. is not responsible for any claims, loss or damage. ** For more information regarding UPS Insurance Policy, please visit Insurance charges will be added to all of your invoices, according to the following guidelines: Order Amount x $0.60 / 100 Example: If your order amount is $ , your insurance charge will be: $1, x $0.60 / 100 = $5.40 (Freight and Handling Extra) B. You do not need your shipment insured: B.S.C. Technologies Inc. and/or UPS will not be responsible for any loss or damage for any such shipments. In any case, you are still responsible for paying any invoices within the specified term, including Freight and Handling. Page 3 of 5

4 Ministry of Revenue Retail Sales Tax Branch ONTARIO RETAIL SALES TAX PURCHASE EXEMPTION CERTIFICATE BLANKET Business Name: Business Address: Phone: Fax: Nature of Business: Vendor Permit Number (if applicable): Today s Date / / Day Month Year (This purchase exemption certificate is valid for four years.) Under the provisions of the Retail Sales Tax Act, the above-named business claims exemption from tax on the following items of tangible personal property and on the following taxable services: Computer Hardware and/or Software for RESALE purposes only. Signature of Authorized Person Name of Authorized Person (Please Print) PLEASE ATTACH APPLICABLE COPY OF TAX EXEMPTION DOCUMENTS IMPORTANT The person purchasing the tangible personal property or taxable service for which an exemption is claimed must complete this certificate and give it to the supplier. The supplier is to retain this form as provided by the regulations. This purchase exemption certificate is valid for four years for purchases of the above-listed items and services if, The box beside the word BLANKET at the top of the form is checked; and The purchase order refers to this purchase exemption certificate. Every person who makes a false statement on this certificate or misuses this certificate is liable on conviction, to a fine of not less than $ and not more than $10, plus an amount of not more than double the amount of the tax that should have been declared to be collectable or payable or that was sought to be evaded, or to imprisonment for a term of not more than two years or to both. Page 4 of 5

5 CREDIT CARD AUTHORIZATION FORM Legible photocopies of both sides of your credit card and driver s license are required. The cardholder must be one of the Company Principals listed on this application from. I am the authorized signatory for the credit card listed below and give B.S.C. Technologies Inc. permission to charge this credit card for future purchases placed on my B.S.C. Technologies Inc. account. Company Name: Company Address: Province: Postal Code: Postal Code: Phone No.: PRIMARY CARD Type of Card: Visa Card MasterCard merican Express Diners Club Credit Card Number: Expiry Date (Month/Year): Name of Cardholder (as it appears on card): Title of Cardholder: Authorized Person who may use this Card: Home Phone No. Billing Address of Credit Card: Province: Postal Code: CREDIT CARD INFORMATION ALTERNATE CARD Type of Card: Visa Card MasterCard American Express Diners Club Credit Card Number: Expiry Date (Month/Year): Name of Cardholder (as it appears on card): Title of Cardholder: Authorized Person who may use this Card: Home Phone No. Billing Address of Credit Card: Province: Postal Code: I am the authorized signer on the above card(s) and hereby give permission to bill my credit card when requested. I understand that it is solely my responsibility to make any changes in authorized persons who may use these cards in writing to B.S.C. Technologies Inc. Additionally, I agree not to dispute any credit card charges after thirty (30) days of the purchase. Furthermore, I agree to take up any questions regarding my account with B.S.C. Technologies Inc. directly. Signature of Cardholder: Title: Name of Cardholder: (Please Print) Date: Page 5 of 5

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