Let's Do Business! - Mirror Metals

Step 1 of 5 - Credit Application

Applicants Legal Name*
Physical Address*
Street Address Address Line 2 City State ZIP Code
Billing Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Fax Number
Federal ID Number (FEIN)*
D&B#
Resale# & State Issued*
Type of Entity
State of Incorporation
Month/Year Incorporated
Bankruptcy
If Yes, Date & State of Filing
Owner(s) or Officers name & Title*
Name, Address, Phone#, Fax #
Metal References (minimum of 3 required)*
Name, Address, Phone#, Fax #
Bank Name
Bank Address
Officer Name
Account #
Bank Contact Phone
Accounts Payable Contact*
First Last
Phone
Owner or Officer Signature*
Date*
Date Format: MM slash DD slash YYYY
Signers Name*
First Last
Title*

BANK AUTHORIZATION FOR CREDIT
Date*
Date Format: MM slash DD slash YYYY
Applicant*
To:*
Account #*
WE HEREBY AUTHORIZE THE BANK, TO GIVE INFORMATION ON OUR ACCOUNTS WITH THIS BANK, TO MIRROR METALS SO THAT WE MAY BE CONSIDERED FOR AN OPEN LINE OF CREDIT WITH THEM.
Signature*

STANDARD TERMS AND CONDITIONS
1. CUSTOMER will pay invoices in full within 30 days of the invoice date.
2. If payment is not received by the SELLER on or before the invoice due date, the account shall be subject to a service charge up to the maximum allowed by law.
3. In the event, the account is placed in the bands of a licensed collector or an attorney for collection, or a suit is instituted, CUSTOMER agrees to pay, in addition to the delinquent amount, service charges, actual court costs, collector's and/or attorney's fees. The provisions of the contract shall be governed by the laws of the state of California; the venue shall be Ventura County, California.
4. All claims for shortage, damage or defective materials are waived unless made in writing within ten (10) days of shipment.
5. All returns of materials may be subject to a restocking charge.
Full Legal Name of Firm*
Full Name & Title*
Signature*
Date*
Date Format: MM slash DD slash YYYY

I HEREBY CERTIFY:
I hold a valid seller's permit number:*
Enter Permit number
I am engaged in the business of selling the following type of property:*
List type of property
This certificate is for the purchase from MIRROR METALS of the item(s) I have listed in paragraph 5 below.
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.
Description of property to be purchased for resale:*
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*
First Last
Signature of Purchaser, Purchaser's Employee or Authorized Represenative*
Name of Person Signing*
First Last
Title*
Address of Purchaser*
Phone*
Upload Valid Resale Certificate
Date*
Date Format: MM slash DD slash YYYY

Do you want your Mirror Metals invoice emailed instead of mailed?
Select One*
- YES, I prefer to receive my invoices via email, instead of a hard copy
- NO, send me hard copy invoices
Company Name
Email*
Signature*
Name
First Last
Date*
Date Format: MM slash DD slash YYYY

Let’s Do Business!

Step 1 of 5 - Credit Application

BANK AUTHORIZATION FOR CREDIT

STANDARD TERMS AND CONDITIONS

Do you want your Mirror Metals invoice emailed instead of mailed?