Company Name: Company Owner/President: Primary Contact: Years in Business: Resale License Number: Email: Federal Tax ID# Approx. Sale Radius: NEW ACCOUNT REQUEST FORM ATTN: VALERIE TEL. (800) 842-0590 FAX (323) 888-4350 EMAIL: [email protected] Please fax a copy of your Resale License or Sales Tax License that is given by your State ***Department of Revenue, Department of Taxation, Tax Commission, Comptrollers Office, etc.*** Address: City/State/Zip: Phone: Fax: BILL TO Answer the following: (Circle your answer) Are you a new car dealer? Are you a used car dealer? Are you an O.E.M. dealer? Are you a mobile installer? Are you an automotive restyler? Do you sell to new car dealerships? Do you sell via the Internet? Do you sell to retail customers? Will you be purchasing raw material (hides & vinyl)? Will you be purchasing Katzkin leather interiors? YES NO YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO Payment preference? (check one) Cashiers Check Money Order Company Credit Card Wire Transfer *All international accounts must choose Wire Transfer* NOTE: Along with this application, you must submit a Sellers Permit, Sales Tax Permit, or Resale Certificate. If you wish to pay with a company check, you will need to complete a Credit Application. This process takes 2-3 weeks All requests are subject to approval. We will contact you within 72 hours. International customers must provide a copy of their business license (or equivalent documentation) identifying you as a business. SHIP TO *NOTE: We do not ship to home address w/out a release and approval* Address: City/State/Zip: Phone: Fax: 1