OtterBox: Application for Credit

Important: All items on this Credit Application MUST be completed in full. Failure to provide all requested information may result in delay or denial of credit approval. By completing this form it is understood that all terms set forth in Otter Products LLC Terms & Conditions of Sale will be binding. An Authorized Signature is required for your request to be processed.

Company Name *This question is required.

Date *This question is required.

DBA

Phone *This question is required.

Fax

Email Address *This question is required.

Billing Address *This question is required.

City *This question is required.

State *This question is required.

Postal Code *This question is required.

Country *This question is required.

Shipping Address *This question is required.

City *This question is required.

State *This question is required.

Postal Code *This question is required.

Country *This question is required.

Accounts Payable Contact *This question is required.

Phone Number *This question is required.

A/P Email Address *This question is required.

Invoices are sent by email. What email address do you want them sent to? *This question is required.

If you are unable to receive your invoice via email, please indicate special mailing instructions

Have you ever filed Bankruptcy? *This question is required.

No
Yes

If yes, Chapter

Year

Type of Entity *This question is required.

Year Incorporated *This question is required.

State/Country *This question is required.

Years under present ownership *This question is required.

OtterBox Business Solutions Representative you've been working with *This question is required.

Copy of Names & Addresses of Proprietors, Partners, or Corporate Officers:

Name/Title *This question is required.

Phone *This question is required.

Address *This question is required.

Name/Title

Phone

Address

Tax I.D. Number *This question is required.

If Proprietorship, Owner Social Security Number

Dun & Bradstreet Number *This question is required.

Name of Bank *This question is required.

Contact Name *This question is required.

Title *This question is required.

Phone Number *This question is required.

Fax

Email Address *This question is required.

Address *This question is required.

City *This question is required.

State *This question is required.

Country *This question is required.

Business/Trade References (companies that you currently have a line of credit with)

Company name *This question is required.

Direct contact *This question is required.

Direct phone number *This question is required.

Extension

Email *This question is required.

Address *This question is required.

Company name *This question is required.

Direct contact *This question is required.

Direct phone number *This question is required.

Extension

Email *This question is required.

Address *This question is required.

Company name *This question is required.

Direct contact *This question is required.

Direct phone number *This question is required.

Extension

Email *This question is required.

Address *This question is required.

Company name *This question is required.

Direct contact *This question is required.

Direct phone number *This question is required.

Extension

Email *This question is required.

Address *This question is required.

Revolving Line of Credit Requested: $ *This question is required.

**Required, Cannot Process Without**

**ADDITIONAL INFORMATION MAY BE REQUESTED** We certify that all the information on this form is true and correct. Authorization is given to Otter Products, LLC to investigate and confirm the above information through its customary sources. Please understand that credit may be stopped if the account exceeds the agreed credit limit, or falls into arrears and further action may be taken at the discretion of Otter Products, LLC. We have received and understand the credit terms as listed on the Otter Products LLC Terms & Conditions of Sale and agree in consideration of extended credit.

Authorized Signature *This question is required.

Title *This question is required.

Date *This question is required.

Terms and Conditions *This question is required.

I have read and agree to the terms and conditions