Mercury Adhesives Wholesale Request

Application For Dealership

Shop Information: * items are required.
Shop /
Trading Name: *
Business is a: *

Name of Corporation or legal entity (if necessary):
 
Shop Address: *
City: *
State: *
  Zip / Postal Code: *
Shipping Address:
City:
State:
 Zip / Postal Code:
Shop Phone Number: *
Shop Email: *
Shop URL:
State Sales Tax /
Resale Number: *
Federal EIN Number: *
Store Location: *

Weekly Hours Open:
Store Size (sq feet):
Primary Method of Sale:

Other  
# of Employees:
Full Time:   Part Time:
Date Shop Opened:
 
Owner's Information: Please list the names of all owners or principles of the company. Additional can be entered in the comments.
#1 Name: *
Home Address: *
City: *
State: *
 Zip / Postal Code:
Home Phone Number: *
Personal Email Address: *
#2 Name:
Home Address:
City:
State:
 Zip / Postal Code:
Home Phone Number:
Personal Email Address:
 
Credit References:
If this is a new shop with no references, click here:
#1 Name:
Address:
City:
State:
 Zip / Postal Code:
Phone Number:
Fax Number:
#2 Name:
Home Address:
City:
State:
 Zip / Postal Code:
Phone Number:
Fax Number:
 
Banking References:
Bank Name:
Address:
City:
State:
 Zip / Postal Code:
Phone Number:
Contact Person:
Main Account Number:
 

The Agreement Fine Print

The undersigned acknowledge that the information supplied on this form is correct. Should any of this information change once an account has been established, I/we understand this account may be subject to review and possible re-establishment of the account may be required including a new application and photographs. All information supplied on this application is the confidential property of Mercury Adhesives.

I/we understand and acknowledge that by placing an order with Mercury Adhesives constitutes doing business in Georgia, and is subject to the laws of the State of Georgia.

The undersigned acknowledge for the purpose of establishing and maintaining an open account with Mercury Adhesives, periodic credit inquires including business and personal credit reports and bank references are authorized. The granting of any credit line is the sole responsibility of Mercury Adhesives, and may be discontinued at any time without reason.

The undersigned authorize Mercury Adhesives to make whatever credit and/or business inquires it deems necessary in the establishment of this account. Furthermore, I/we authorize and instruct any person or credit reporting agency to report any information to Mercury Adhesives it may have in response to such credit and/or business inquiries.

For payment by Paypal or credit card add 3%. Shipping is FOB Atlanta, unless the minimum order amount is made and then shipping is free. Local pick up is available. We normally ship UPS and are happy to bill the freight to your UPS account or charge it to your account.

If credit is established, the undersigned agree to pay all open account invoices in full within 15 days of date of receipt of goods. I/we acknowledge that all amounts not paid by the 15th day after receipt of goods are subject to a FINANCE CHARGE of 1.5% per month (18% ANNUAL PERCENTAGE RATE) applied to the average daily balance. Should this account be terminated for any reason, all amounts due to Mercury Adhesives become payable at once.

In the event payment of invoice is tendered by check, and that check is dishonored by the bank for any reason, I/we agree to pay a $25.00 charge for each dishonored check. In addition, I/we agree to pay any late payment fees associated with that check.

The undersigned acknowledge that in the event this account becomes delinquent and is turned over to any collection agency or attorney for collection, I/we agree to pay all of Mercury Adhesives collection costs including, but not limited to, reasonable attorney and/or collection fees.

With the establishment of this account I/we agree to abide to all Minimum Advertised policies (MAP) as established by Mercury Adhesives as it relates to the products I/we carry. Map price is defined as the suggested price as posted on the Mercury Adhesives web site.

I/We agree to provide reasonable technical support to customers, including without limitation:
Assigning trained and competent technical personnel who are sufficiently knowledgeable with respect to Mercury products in general and the products purchased from Mercury Adhesives in particular to answer customer questions regarding the use of the products.

I/we understand that Mercury Adhesives has no control over the final use of the Mercury products purchased from your company or the manner in which the products are used and maintained. Thus, no liability is assumed or accepted for any damage resulting from the use of the products including but not limited to direct, indirect, incidental, special, and consequential damages.

I/we understand that I/we may not transfer or assign any of our rights or obligations under this agreement without the prior written consent of Mercury Adhesives.

I/we agree to keep any and all correspondences as well as wholesale pricing matters confidential at all times.

I/WE AGREE THAT MERCURY ADHESIVES AND ITS OFFICERS, DIRECTORS, EMPLOYEES, OR AGENTS WILL NOT BE LIABLE, WHETHER IN CONTRACT, TORT, NEGLIGENCE, STRICT LIABILITY OR OTHERWISE, FOR ANY DAMAGES OF ANY KIND WHATSOEVER, INCLUDING DIRECT, INDIRECT, PUNITIVE, SPECIAL, CONSEQUENTIAL AND INCIDENTAL DAMAGES (INCLUDING WITHOUT LIMITATION LOST PROFITS, COST OF PROCURING SUBSTITUE SERVICE OR LOST OPPORTUNITY) ARISING OUT OF OR IN CONNECTION WITH THE SALE OR USE OF RODUCTS PURCHASED FROM MERCURY ADHESIVES OR THE MANFACTURES OF THE PRODUCTS PURCHASED FROM MERCURY ADHESIVES, OR THE USE OF ANY RELATED PRODUCTS USED WITH THE PRODUCTS PURCHASED FROM MERCURY ADHESIVES OR THE DELAY OR INABILITY TO USE THE PRODUCTS, EVEN IF MERCURY ADHESIVES WAS MADE AWARE OF THE POSSIBILITY OF SUCH DAMAGES. THIS EXCLUSION OF LIABILITY INCLUDES, BUT IS NOT LIMITED TO, OPERATOR ERRORS, OR ANY FORCE MAJEURE. MERCURY ADHESIVES CANNOT AND DOES NOT GUARANTEE THE PRODUCTS IN ANY WAY. FURTHERMORE, YOU AGREE TO INDEMINFY MERCURY ADHESIVES AGAINST LIABILITY FOR ANY AND ALL USE OF THE PRODUCTS PURCHASED FROM MERCURY ADHESIVES.

 
I have read the terms of this agreement, understand all clauses and agree to the terms: *
 
* Signature:
* Title:
Digital Audit Question
*Month born in:
 
Corporations and Limited Liability Companies Only
I/we hereby personally guarantee that the statements on this application are true and guarantee to any indebtedness to Mercury Adhesives incurred by
Name of Corporation or Limited Liability Company:
 
Individual Guarantor/Owner:
 
Comments:

Merchant Information

Mercury products are sold the world over through many retail locations. Mercury does not sell direct to consumers and knows that the level of service you will receive direct from one of it’s dealers will complement the Mercury products.

If you are a retail outlet, Mercury would love to add your company’s name to the growing list of very happy and profitable Mercury retailers. To feature the quality and profitable Mercury products in your location just fill out our application or download the application and mail or fax it in.

Mercury Adhesives