RETAIL APPLICATION FORM Step 1 of 3 - ACCOUNT & COMPANY INFO 0% NAME First Last PHONE #COMPANY INFORMATIONCOMPANY NAMEAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code BUSINESS PHONE#FAX#EINCOMPANY TYPE CORPORATION PARTNERSHIP SOLE PROPRIETOR LLC SHIPPING ADDRESS Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code COMPANY ANNUAL SALESYEARS IN THE BUSINESSOWNER INFOOWNER'S NAME First Last SSNDOB Date Format: MM slash DD slash YYYY Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code TYPE Select All PLACEMENT PRODUCTS TERM ACCOUNTS WHOLESALE ACCOUNTS 1. TRADE REFERENCENAMETYPE OF BUSINESSPRODUCTS SOLDPHONE NUMBERTAX ID2. TRADE REFERENCENAMETYPE OF BUSINESSPRODUCTS SOLDPHONE NUMBERTAX ID3. TRADE REFERENCENAMETYPE OF BUSINESSPRODUCTS SOLDPHONE NUMBERTAX ID I agree to the Terms & Conditions.VFD TERMS AND CONDITIONS 1. These terms and conditions of sale shall apply to all sales of goods by V.F.D. (Next World Communications program). No terms or conditions of a purchase order that differ from these terms and conditions of sale will become part of any contract unless approved by the company in writing. 2. SALE: The goods must be purchased exclusively for sale. No purchase order may be cancelled or modify without the prior approval of the company (Next World Communications). Buyer shall have no right to return any goods exempt with the express authorization of the company, which is the company’s sole discretion, but in no event more than thirty days (30) after the invoice date. 3. WARRANTIES: Suppliers makes no express or implied warranties in connection with the sale of the products, including any express or implied warranty or merchantability or fitness for a particular purpose nor any warranty for non-infringement of any intellectual property. 4. All information will be held in strict confidence and be used only for the purpose of extending credit to retail/term account. 5. RETURN PAYMENT: All return payment will assessed $35.00 N.S.F fee. This fee must be paid before the next order. NSF Fee can be paid with cash, credit card, and debit card. All debit and credit card payment will be subject to 4% Discount to cover all brand fees and surcharges. 6. LATE PAYMENTS: If your payment is late there will be a 5% late fee assess to your balance. All late fees be must be paid with balance at once or with payment arrangement. 7. RESTOCKING FEE: In the event of merchant returning any products back to company, merchant will be charged of restocking fee or a percentage of the return. This percentage may vary from 9% to 15%. 8. COLLECTION: If merchant fail to pay any outstanding balance. We, the company have the right to refer to debt to a collection service for the purpose of collecting this debt. After referring any outstanding balance to a collection service, you may be charged additional fees toward your debt. 9. DELIVERY FEE: Be aware there may be fuel surcharge to merchant for delivery of products. 10. REFERRAL: If the merchant refer a new referral to our program. Next World Communications Inc. will provide a one-time discount as a thank you gesture. This discount will not be more than 3%. 11. WHOLESALE ACCOUNT: This program require payment in full at the time of delivery or prior to delivery. 12. TERM ACCOUNT: Term account is set for a specific number of weeks or days of a pay period. These term limits are: weekly, bi- weekly, tri-weekly or monthly. 13. PLACEMENT ACCOUNT: Placement account is simply when merchant agrees to pay the wholesale price with a margin of interest in exchange of multiple payment breakdowns over several weeks. 14. All payments are final and no refunds are acceptable. 15. You authorize regularly schedule changes to your checking/savings account. You will be charged the amount indicated below each billing period. A receipt for each payment will be provided to you and the charge will appear to your bank statement as an “ACH DEBIT”. You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected. Date Date Format: MM slash DD slash YYYY Printed NameACH INFORMATIONName as it appears in BankBank NameRouting NumberAccount Number I accept.ACH AUTHORIZATION I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify __________________ in writing of any charges in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted dates fall on a weekend or holiday. I understand that the payment maybe executed on the next business day. For ACH Debits to my checking/savings account. understand that these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that Next World Communications may at its own discretion attempt to process the charge again within 30 days, and agree to pay an additional $____________ charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH Transactions to my account must comply with the provisions of US Law. I certify that Next World Communications is an authorized user of this bank account and will not dispute these scheduled transactions with my bank, so long as the transactions correspond to the terms indicated in this authorization form. Certificate of ResaleAccepted file types: jpg, png, pdf.Void Check w/ E CheckAccepted file types: jpg, png, pdf.Driver's LicenseAccepted file types: jpg, png, pdf.Business LicenseAccepted file types: jpg, png, pdf.5 to 10 pictures of the Business (inside/outside) Drop files here or Accepted file types: jpg, png, pdf. * By entering the phone number, you agree to Self-serve's TOS. Message and data rates may apply.* This iframe contains the logic required to handle Ajax powered Gravity Forms. OUR COMPANY ABOUT US PARTNER WITH US CAREERS NON PROFIT PROGRAM CUSTOMER SERVICE BILLING / PAYMENTS FAQS EVENTS LIQUIDATION KNOWLEDGEBASE ADDITIONAL SERVICES POS SYSTEM MERCHANT ACCOUNT / CREDIT CARD BUSINESS LOAN DIGITAL MENU INTERNET / BUSINESS PHONE CONNECT WITH US! FollowFollowFollowFollow 844-985-VFD1 844-985-8331 424-254-1362 By entering the phone number, you agree to Self-serve's TOS. Message and data rates may apply.
