Supreme Suspensions Dealer Application

DEALER APPLICATION
Company Profile
Company Name*
Name*

First NameLast Name
Title
Phone Number*
E-mail*
example@example.com
Website
Business Address
International Address
Company Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Company Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shipping Address
Same as Business Address
Same as Business Address
Company Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code
Company Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Type
Please Select All That Apply*

Auto Parts DealerInstallationInternet RetailerPhysical Retail StoreOther
Type of Internet Retailer (check all that apply)*

ResellerDropshipper
Resellers will fulfill their online orders. Dropshippers will have Supreme Suspensions® fulfill online orders.
Number of Install Bays
Number of Employees
Year Established
Receiving Hours
Resale Tax Certification #*
Business License #*
Intended Products to Purchase
If you know which product(s) you would like to purchase, please enter the Product ID, Title, orSKU, below.
Retail, Internet, eBay, & Amazon Sales
eBay and Amazon Listings are not permitted. Retails stores and online stores may not advertise
Supreme Suspensions prices less than 5% off MSRP. Violation of these terms may result in suspension or termination of dealer account.
I accept these terms*
Date*

MonthDayYear
Date
Print Name*
Signature*

Clear
Are you a California Seller

Yes, I am a California ResellerNo, I am not a California Reseller
Next - California Resale Certificate
Next - Terms & Conditions

California Resale Certificate
I HEREBY CERTIFY:
1. I hold valid seller’s permit number:*
2. I am engaged in the business of selling the following type of tangible personal property:*
3. This certificate is for the purchase from [Vendor]* of the item(s) I have
listed in paragraph 5 below.
4. I will resell the item(s) listed in paragraph 5, which I am purchasing under this resale certificate in the form of tangible personal property in the regular course of my business operations, and I will do so prior to making any use of the item(s) other than demonstration and display while holding the item(s) for sale in the regular course of
my business. I understand that if I use the item(s) purchased under this certificate in any manner other than as just described, I will owe use tax based on each item’s purchase price or as otherwise provided by law.
5. Description of property to be purchased for resale:*
6. I have read and understand the following:

For Your Information: A person may be guilty of a misdemeanor under Revenue and Taxation Code section 6094.5 if the purchaser knows at the time of purchase that he or she will not resell the purchased item prior to any use (other than retention, demonstration, or display while holding it for resale) and he or she furnishes a resale
certificate to avoid payment to the seller of an amount as tax. Additionally, a person misusing a resale certificate for personal gain or to evade the payment of tax is liable, for each purchase, for the tax that would have been due, plus a penalty of 10 percent of the tax or $500, whichever is more.
Name of Purchaser*
SIGNATURE OF PURCHASER, PURCHASER’S EMPLOYEE OR AUTHORIZED REPRESENTATIVE*

Clear
PRINTED NAME OF PERSON SIGNING*
Title
Address of Purchaser*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Date*

MonthDayYear
Date
Next - Terms & Conditions

Terms & Conditions
1. Applicant’s signature attests financial responsibility, willingness and ability to pay our invoices in accordance with the payment terms, which may be granted, and in accordance with Supreme Suspensions published terms and policies as may be revised from time to time. All information is required to assess credit terms. Additional documents and/or information may be required as a condition of sales or credit terms.
2. You must purchase merchandise for the sole purpose of resale.
3. A service charge of $25.00 or 5%, whichever is greater, will be charged on any returned checks. If two checks are returned for any reason, the account will be placed on CASH or Money Order only.
4. Applicant also assumes responsibility for all bills contracted in his name at the designated address, and, if required to collect delinquent accounts, all collection agency, attorney expenses and court costs.
Signature*

Clear
Date*

MonthDayYear
Date
By submitting this application, I hereby state that the information provided is accurate to the best of my knowledge.

I understand that my application will be reviewed and upon approval, I will be contacted by a Supreme Suspensions Dealer Account Manager to finalize my Dealer Account Discounts.
Should be Empty:

DEALER APPLICATION

Company Profile

Business Address

Shipping Address

Business Type

Intended Products to Purchase

Retail, Internet, eBay, & Amazon Sales

California Resale Certificate