DEALER & CREDIT

APPLICATION
(Larry Locks

GENERAL BUSINESS INFORMATION

Business Name:
DBA or AKA:
Billing Address:
City, State, Zip Code
Shipping Address (if different):
City, State, Zip Code
Business Telephone:

E-mail:

Business Fax No.

Established

Federal Employer Tax ID No.

Resale Certificate No.
Business Type: [ ] Sole Proprietor [ ] Private Corporation [ ] Public Corporation [ ] Partnership
[ ] Limited Liability Partnership [ ] Limited Liability Company [ ] Other
FINANCIAL AND CONTACT INFORMATION
Buyer
Accounts Payable Contact

Telephone:

Email:

Telephone:

Email:

Annual Sales:

No. of Employees
Do you require a written purchase order? [ ] yes [ ] no
Person(s) Authorized to Purchase:
BANK INFORMATION
Bank Name

Telephone:

Bank Address

Fax:

City:

State:

Bank Officer to
Contact:

Zip Code:
Checking Account Number:

Page 1 of 3

6290 Northern Blvd. East Norwich, NY 11732 Tel: 516-628-8486 Fax: 516-740-5814
customersales@usasummit.com www.usasummit.com

Website: _____________________ % of online sales: ____________________

Product lines you are interested in: (Please check all that apply)
Aqua Box

Drift

Epic - GSM

Loksak

S3

Watershed

Aqua Case

Dry Case

Goal Zero

Nautical Trivia

Spotlight

Witz

Aquapac

Dry Pak

H2O Audio

OtterBox

Storm Case

Lifeproof

Bonaire

eGear

Keyhole

PC Shade

Ultimate Survival

Markets Serviced (Please check only one that best applies)

Boating & Marine
Consumer
Electronics

Digital Photography
E-Commerce

Hunt & Fish

Motor Sports

Outdoor
Sporting Goods

Sport Specialty
Surf & Sail

Winter Sports
Other

PLEASE COMPLETE THE FOLLOWING IF YOU ARE APPLYING FOR OPEN CREDIT TERMS:
TRADE REFERENCES
1st Reference

Phone

Address

Fax

City:

State:

Zip Code:

2nd Reference

Phone

Address

Fax

City:

State:

Zip Code:

3rd Reference

Phone

Address

Fax

City:

State:

Zip Code:

Page 2 of 3

6290 Northern Blvd. East Norwich, NY 11732 Tel: 516-628-8486 Fax: 516-740-5814
customersales@usasummit.com www.usasummit.com

Credit Terms
The credit applicant (hereafter CUSTOMER) agrees to and understands the following:
The information provided on this credit application is for the purpose of obtaining credit from USA Summit Distribution,
LLC. (hereafter Summit) and warrants that the information provided is accurate and true. Summit is induced to extend
credit to the CUSTOMER by reliance upon the CUSTOMERS written statements on this credit application. If credit is granted,
CUSTOMER understands that the terms of the sale are set forth in the sales agreement between CUSTOMER and Summit, or if
there is no agreement, 30 days net. CUSTOMER agrees to pay all Summit invoices within these terms or such more favorable
terms as Summit may offer from time to time. Summit reserves the right to change the credit terms of any CUSTOMER.
In the event any invoice is not paid when due, a late charge of 1.5% per month (18% annual percentage rate) or the highest
rate permitted by applicable law may be assessed. Such late charge will be paid within 30 days of the date the charge is
assessed.
Oral statements made by sales people or other representatives are not binding on Summit.
CUSTOMER understands and agrees that Summit is not obligated to make extensions of credit. Extensions of credit are
subject to the discretion of Summit. In the event of non-payment of any invoice when due the extension of credit may be
suspended or terminated at the discretion of Summit. Any waiver of any default or extension of time shall not operate as a
waiver of any other default or extension of time. This right shall be a continuing one.
If CUSTOMER fails to pay any indebtedness to Summit when due, Summit at its option may declare the entire balance of
CUSTOMERS indebtedness to Summit in default. Upon written notice to CUSTOMER such entire balance of indebtedness shall
become immediately due and payable.
These credit terms shall be construed in accordance with the laws of the State of New York.
In the event that the account is placed with a third party for collection, CUSTOMER agrees to pay all costs including
reasonable attorney fees, court costs, and finance charges.
CUSTOMER agrees to immediately notify Summit in writing by certified mail return receipt requested, of any change in
ownership, form of business, or address, or the termination of a persons authority to incur charges under the account on
behalf of the CUSTOMER and indemnify Summit for any loss incurred as a result of CUSTOMERS failure to provide said
written notice.
A signed faxed copy of this credit application will be considered the original.
CUSTOMER authorizes Summit, and/or its agents to investigate CUSTOMERS credit history, bank references, trade references
and any information Summit deems reasonably necessary to extend credit.
CUSTOMER agrees to remit all payments to the following remittance address:
Checks should be mailed and be made payable to:
Summit Distribution
6290 Northern Blvd.
East Norwich, NY 11732
CUSTOMER AUTHORIZED SIGNATURE(S)
The undersigned CUSTOMER represents that he/she is authorized to execute this application. (If your firm is a
corporation, LLC, LLP, or partnership the application must be signed by two corporate officers, two members, or two
partners).

Signature

Print Name

Title

Date

_________________________________________________________________________________
CREDIT APPLICATION HAS THREE (3) PAGES.
COMPLETED AND SIGNED CREDIT APPLICATION MAY BE FAXED TO 516-740-5814
Page 3 of 3

6290 Northern Blvd. East Norwich, NY 11732 Tel: 516-628-8486 Fax: 516-740-5814
customersales@usasummit.com www.usasummit.com

Amazon Merchant Contact Information Form

If you are a Dealer that utilizes the Amazon Merchant Platform to sell the product lines we sell you, we are required by
our Brands to collect the following contact information. This information will identify you as an Authorized Amazon
Summit Dealer and enable us to contact you if MAP violations and so on arise.

I do NOT Sell on AMAZON, and do not have an Amazon Merchant Name (skip to # 4).

1. What is your Amazon Merchant Name?

(The name you use that people see when you list an item) __________________________________________________
2. If we need to contact you, what is the best telephone number to use: ________________________________________
3. If we need to contact you, what is the best email address to use: ____________________________________________
4. Your Name: __________________________________________________________________________________________
5. Your Company Name: _________________________________________________________________________________
6. Your Address: _______________________________ City: ________________________ State: __ __ Zip: __ __ __ __ __

I agree to the following terms and conditions:

1. Will adhere to all manufacturers MAP Policy.
2. Will only sell the products we purchase from Summit Distribution to consumers/end-users and will not resell to
any other reseller of any kind.
3. Will not ship the products we purchase from Summit Distribution to any customer located outside the United
States.
Your Name: ___________________________________________________________________
Signature: ______________________________________ Your Title: _______________________________
Todays Date: _________________________________________

6290 Northern Blvd.

East Norwich

NY 11732 516-628-8486 516-740-5814

www.usasummit.com

Authorized Lifeproof Dealer Application & Agreement

Thank you for contacting Summit Distribution (Summit) to become an Authorized Lifeproof dealer. It is Summits
responsibility to grow Lifeproofs market share in the USA, but more importantly, to protect and maintain Lifeproofs
brand integrity and value. That said, all resellers requesting to become and authorized Lifeproof dealer must complete
the following application form, be approved by Summit, and agree to all terms and conditions.

Are you a current Summit customer? ___________________

What is the Primary market you serve: (Check just one)
o Boating & Marine
o Consumer Electronics
o Digital Photography
o E-Commerce
o Hunt & Fish
o Motor Sports
o Outdoor
o Sporting Goods
o Sport Specialty
o Surf & Sail
o Winter Sports.

What brands of protective products for electronics do you carry? __________________________

__________________________________________________________________________________

Do you have a "brick & mortar" retail location? __________________

Do you sell online? If yes, what is % of sales sold online? _______________

Other comments: __________________________________________________________________

I agree to the following terms and conditions:

1. Will adhere to Lifeproofs MAP Policy.
2. Will only sell Lifeproof products to consumers/end-users and will not resell Lifeproofs products to any other
reseller of any kind.
3. Will not sell and/or fulfill orders for Lifeproof products through any Internet auction site (such as eBay) or on
any Internet storefront (such as Amazon Marketplace, eBay Stores, or Yahoo! Shopping storefronts) without the
prior written approval of Summit and/or Lifeproof, which may be withheld at Summit's and/or Lifeproofs sole
discretion.
4. Will not ship any Lifeproofs products to any customer located outside the United States.
If any authorized Lifeproof dealer fails to meet the terms of this agreement, Summit reserves the right to terminate its
relationship with said dealer immediately.
Reseller Company Name: ___________________________________________________________________
Signature: ______________________________________ Your Title: _______________________________
Todays Date: _________________________________________

6290 Northern Blvd.

East Norwich

NY 11732 " 516-628-8486 ! 516-740-5814

www.usasummit.com

6290 Northern Blvd., East Norwich, NY 11732

Tel: 516-628-8486 Fax: 516-740-5814 www.usasummit.com

APPLICATION FOR CREDIT CARD OR COD CERTIFIED ACCOUNT

CREDIT CARD or COD CERTIFIED
Company Name ___________________________________________________________________________________________
Legal Name _______________________________________________________________________________________________
Length of Time in Business ________________________ Length of Time at Current Address ___________________________
Address __________________________________________________________________________________________________
City, State, Zip ____________________________________________________________________________________________
Telephone _____________________________________________ Fax ______________________________________________
E-Mail ___________________________________________________________________________________________________
Accounts Payable: E-Mail ALL Invoices To ______________________________________________________________________

Card Type (Check One) American Express MasterCard Visa

Credit Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date (MMYY) __ __/__ __ CVV2 Code _ _ _ _
Card Verification Acc. # (Toll free number on the back of the card) _______________________________________________
Card Holders Name (As printed on the card) ___________________________________________________________________

I do hereby authorize USA Summit Distribution, LLC (Summit) to process credit card transactions from the information provided hereon. I agree that credit card
orders will be charged to my credit card account at the time of shipment. I understand credit card orders are an alternative to credit terms, and orders that are
invoiced under credit terms may not be paid via credit card. I agree that Summit may charge the cost of an order to my credit card account listed above, without
having to obtain the undersigneds signature on each individual credit card transaction. I also agree orders processed under a credit card do not qualify for any
discounts that may be available under credit terms.
I agree that it is my sole responsibility to notify Summit in writing, of any changes to the information listed on this sheet. Summit will not be held liable for any
unauthorized purchases and charges to the credit card account(s) listed above as a result of failure to receive written notification of said changes. I agree in the
event any terms or pricing on a purchase order executed by my company are inconsistent with Summit terms, pricing and policies shall take precedence. Summit
must consent to any modifications in writing. I agree to examine merchandise immediately upon receipt, and to advise Summit of any disputed transactions within
10 days of receipt. Failure to notify Summit of any dispute with respect to defective goods shall constitute a waiver of all such disputes. I also agree that my
company is fully responsible for any obligation not paid pursuant to this authorization. My signature below confirms that I have the authority to bind the business
and/or person(s) named above as a customer to this agreement, and that I understand and accept the terms and conditions presented.
I agree to the total amount of the invoice billed to my above listed credit cards. I further agree to pay the total amount in accordance with the card Issuer
Agreement.
Authorized Signature _____________________________________________

Date _____________________________________

Please check if you want Summit to retain this credit card information and automatically bill all future purchases to the above listed credit card
By signing this document, I agree to follow all manufacturer mandates and regulations regarding the purchase and resale of any all products. Mandates can
include but are not limited to: department or agency bids at any level, MAP Polices, geographical product sales restrictions, notifications of stop-sales, resale to
other dealers and distributors, third party e-commerce sales and distribution, use of manufacturer logos and/or trademarks, sale of product via e-commerce
channels, use of proprietary licenses and/or design, and third party shipping by wholesaler or distributor. I understand that Summit has no control over any
restrictions that manufacturers mandates and/or regulate, and I agree to hold blameless and free from fault in any litigation arising from Summits adherence
and/or enforcement of manufacturers mandates. I further understand that any/or all mandates or regulations can change from any manufacturer, at any time
without prior notification. Violation of any of the previously mentioned mandates can result in termination of a dealer account privileges/rights at the discretion of
Summit.