Dealer Application

ORDER TERMS AND CONDITIONS

A service charge of 1.5% per month, which is an annual percentage rate of 18%, will be assessed on all invoices not paid within 30 days of that invoice. There will be a $30.00 charge for NSF checks returned. Purchaser agrees to pay any expenses, including court costs, attorney fees, accrued interest and other costs, incurred by G.T. Luscombe Company, Inc. in collecting any amounts due. By signing with an Electronic Signature, you are accepting these terms and conditions.

***Dealers are not authorized to promote, market, advertise, offer to sell or sell any product on or through any online marketplace or auction service (e.g., Amazon marketplace, Ebay or like websites).***

Company Name

Phone

(###)

###

####

Ship to Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Bill To Same as Ship To?

Yes

Bill to Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Website

Accounts Payable

First Name

Last Name

Email Address

Phone

(###)

###

####

Purchasing

First Name

Last Name

Email Address

Phone

(###)

###

####

How Did You Hear About Us?

Store Type

Type of Products you Currently Sell?

Number of Years in Business?

Has your company or any of its Principals ever filed for bankruptcy?

Yes

If Yes, explain:

Trade References

Name of 3 suppliers of major products and services (Company name, Account#, Address, Phone, Fax)

Terms and Conditions

By clicking the check box you are indicating that you have read and agree to GTL's Terms and Conditions. Dealers are not authorized to promote, market, advertise, offer to sell or sell any G.T. Luscombe Company products on or through any online marketplace or auction service (e.g., Amazon marketplace, Ebay or like websites). Customer agrees and represents all information provided to G.T. Luscombe Company, Inc. (GTL) on this credit application and supporting documents will be true and accurate the best knowledge of Customer. Customer agrees that if any of the information materially changes, Customer will update the credit application information as soon as reasonably possible. Seller may from time to time require updated credit information from Customer to maintain an open account status; failure of Customer to update the credit application from time to time as requested by Seller will be a material default under this Agreement. By completing this application for credit, the Applicant authorizes GTL to contact any trade references listed and/or provided. A service charge of 1.5% per month, which is an annual percentage rate of 18%, will be assessed on all invoices not paid within 30 days of that invoice. There will be a $30.00 charge for NSF checks returned. Purchaser agrees to pay any expenses, including court costs, attorney fees, accrued interest and other costs, incurred by G.T. Luscombe Company, Inc. in collecting any amounts due.

I Agree to the above Terms and Conditions

By signing with an Electronic Signature, you are indicating you've read and accepted all terms and conditions.

Title

Email Address

Today's Date

YYYY

Emailed Invoices Allowed

Yes

If you answered yes, please provide an Email Address for Invoices to be sent.

Business License & Tax Exempt Document Submission:

In order for your application to be accepted please email a copy of your business license & proof of exemption to info@gtluscombe.com. In the email subject please reference your company name and "Dealer Application".

**Disclaimer**

Dealers are not authorized to promote, market, advertise, offer to sell or sell any GTL products on or through any online marketplace or auction service (e.g., Amazon marketplace, Ebay or like websites), without prior written consent from G.T. Luscombe Company, Inc. By signing this above agreement you agree to these terms.