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Dealership Name:
Other Business Names:
Parts Manager Accounts Payable Manager
Federal ID#: Corporation Partnership Sole Proprietor
Address: Owner Tenant
City: State Zip Code:
Telephone: Fax:
State License # State Sales Tax ID# :
Previous address if less than 2 years at present location
Address:
City: State: Zip Code:
Factory Authorized Dealer: Honda Yamaha Kawasaki Suzuki Polaris BMW Harley Ducati Other
(Select all that apply) ATV Off Road Street Watercraft Snow Apparel Only
Commencement of business/Date of incorporation:
Type of business: Website: E-mail
Purchase Order No. Required: Yes No
Name and personal address of owners-shareholder-partner
1
2
3 		Title - Position


S.S.N.and DOB
Bank Information
Bank: Account #:
Address: Telephone:
City: State: Zip Code:
Trade or Business References

Name:
Account #

Tel.: Fax:

Name:
Account #

Tel.: Fax:

Name:
Account #

Tel.: Fax:
The CLIENT Authorizes Does not authorize Nichols Motorcycle Supply, Inc obtain credit information from credit agencies, suppliers, references and banking institutions and to keep same updated for the purpose of granting and maintaining credit privileges to the Client. The Client declares all the information contained herein to be true and accurate and agrees to notify Nichols
Motorcycle Supply, Inc. immediately of any material changes thereto.
Methods of Payment

Depending on the status requested and subject to Nichols Motorcycle Supply, Inc. approval, please indicate your preferred method of payment:

1. COD, Cash/Check on delivery (each delivered pkg.)
2. Credit Card (Visa or Master Card)
3. Wire transfer (Through your banking institution)
4. Company Check (30 Days after Invoice Date - Open)
Amount of Credit Requested:

If you wish to pay by credit card, please fill in the form and authorization below,

I, , from (company), authorize Nichols Motorcycle Supply, Inc. to use the credit card for pre-payment of every shipment that is shipped or if our account is set “payable within 30 days of invoice date”to proceed with payment on the credit card for all due items as shown on the concerned monthly account statement. I also declare that I am the CARD HOLDER.
Credit Card Information:
Visa Mastercard
Card Number: Expiration date:
S.S.N.:

Cardholder Name (as it appears on card):

I understand that automatic payment will be processed at time of shipment as per mentioned above without notification unless specified differently by credit cardholder and/or Nichols Motorcycle Supply, Inc.
Accepted and signed by the CLIENT this day of , 2006
Cardholder E-mail address

Terms and Conditions
The credit applicant understands, agrees and accepts the following terms and conditions of credit, which shall apply to any and all credit extended by Nichols Motorcycle Supply, Inc. to , (hereinafter called the “Client”);
1. Unless stipulated differently on a specific invoice, all invoices are payable on or within 30 days of the invoice date. All passed due accounts shall bear interest of 2% monthly.

2.

 Shipments may be held if the account is past due.
3. Non Sufficient Funds Check will be subject to a $ 35.00 service charge
4. Unless stipulated differently on a specific invoice, all merchandise sold to Client shall remain the sole and absolute property of Nichols Motorcycle Supply, Inc. until full and final payment and the Client agrees to keep said merchandise protected and insured against loss and free and clear of all seizures, liens and encumbrances. Nichols Motorcycle Supply, Inc. reserves the right to enter into Client’s premises and retrieve all unpaid merchandise.
5. Nichols Motorcycle Supply, Inc. may at its discretion and upon giving notice to Client, transfer title and ownership, to some or all of the merchandise sold to the Client, in return for which, Client grants additional security of payment to Nichols Motorcycle Supply, Inc. by giving Nichols Motorcycle Supply, Inc. the right to register or publish liens and/or moveable mortgages against Client’s present and future, corporeal and incorporeal assets, without prejudice to any other legal remedies available to Nichols
6. The Client agrees to promptly notify Nichols Motorcycle Supply, Inc. of any changes in the Client’s business name, address, ownership, partnership and/or shareholders.
7. In the event of CLIENTS’s and/or GUARANTOR’s default or bankruptcy, or in the event of CLIENT’s and/or GUARANTOR’S failure to comply with these terms and conditions, Nichols Motorcycle Supply, Inc. may immediately and without notification or indemnity, cancel the CLIENT’s credit privileges, rendering all outstanding amounts immediately due and payable, without prejudice to all other rights and recourses available to Nichols Motorcycle Supply, Inc. at that time.
8. The Client authorizes Nichols Motorcycle Supply, Inc. to obtain banking and credit information and to update same as may be required in connection with this credit application or the renewal or extension of credit thereafter. In doing so, Nichols Motorcycle Supply, Inc. is authorized to disclose trade information concerning the Client to any credit reporting agency, or to any person with whom the Client has or proposes to have financial relations.
9. The Client shall pay all collection and legal costs, including attorney’s fees, incurred by Nichols Motorcycle Supply, Inc., should collection proceedings be necessary due to the Client’s default hereunder.
10. Any litigation between the parties shall be referred to the courts having jurisdiction within the State of Illinois, or at Nichols Motorcycle Supply, Inc.’s option, to the courts having jurisdiction in the judicial district in which the Client’s place of business is located.
11. The information given in the credit application is warranted to be true and correct and given for the purpose of obtaining and maintaining credit privileges.
12. The undersigned possess the authority to bind the Client and are duly authorized to execute these presents
13. A signed application transmitted by fax, and/or received by electronic mail from Client’s Internet address shall be deemed an original copy for the purposes hereof.
 
ACCEPTED AND SIGNED BY THE CLIENT AT , STATE OF ON THIS: Day of 20

ACCEPTED AND SIGNED BY THE CLIENT AT , STATE OF ON THIS: Day of 2006
Name: Title E-mail address
Name: Title E-mail address
Name: Title E-mail address


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