COMPANY INFORMATION
Corporation/ Company name
Business Phone
Cell Phone
E-mail
Company Address
City
State:
ZIP Code
Country
Date Established
Sales Tax ID
EIN#
Type of Business (Individual, Proprietorship, Partnership, or Corporation):
Business Category:
Retail:
Wholesale:
Distributor:
BANKING INFORMATION
Bank Name:
Account Name:
Account Name:
ABA/Routing No
SWIFT
Address
City
State
ZIP Code
Country
NAMES OF OFFICERS/PRINCIPALS/OWNERS
Name
Email
Direct Telephone
Home Address
City
State
ZIP Code
Country
Identification Number (Driver's License or Passport Number. Please Attach Copy)
NAMES OF OFFICERS/PRINCIPALS/OWNERS
1. Position
Name
Email
Direct Telephone
Home Address
City
State
ZIP Code
Country
Identification Number (Driver's License or Passport Number. Please Attach Copy)
File Upload
2. Position
Name
Email
Direct Telephone
Home Address
City
State
ZIP Code
Country
Identification Number (Driver's License or Passport Number. Please Attach Copy)
File Upload
3. Position
Name
Email
Direct Telephone
Home Address
City
State
ZIP Code
Country
Identification Number (Driver's License or Passport Number. Please Attach Copy)
File Upload
Business References
1. Company Name
Address
City
State
ZIP Code
Country
Phone
Fax
Email
Credit terms/Limits
Business References
2.Company Name
Email
Address
City
State
ZIP Code
Country
Phone
Fax
Email
Credit terms/Limits
Business References
3.Company Name
Address
City
State
ZIP Code
Country
Phone
Fax
Email
Credit terms/Limits
PERSON(S) AUTHORIZED TO PICK UP MERCHANDISE
Name
Phone
Name
Phone
Name
Phone
FREIGHT FORWARDER/COURIER
Company Name
Phone
Address
Fax
Contact
Email
Please note the above authorized agent is authorized for Export control, U.S. Customs, and Census Bureau purposes to
transmit such export information electronically that may be required by law or regulation in connection with the exportation
or transportation of any goods on behalf of said Foreign Principal Party in Interest. The Foreign Principal Party in Interest
certifies that necessary and proper documentation to accurately transmit the information electronically is and will be
provided to the said Authorized Agent. The Foreign Principal Party in Interest further understands that civil and criminal
penalties may be imposed for making false or fraudulent statements or for the violations of any U.S. laws or regulations on
exportation and agrees to be bound by all statements of said authorized agent based upon information or documentation
provided by the U.S. Principal Party in Interest to said authorized agent.
BUYER'S RESPONSIBILITY CLAUSE AND COMPLIANCE WITH ANTI-MONEY LAUNDERING INITIATIVES Customer Acknowledges and agrees that the goods, software, and technology subject to this Agreement are subject to the
export control laws and regulations of the United States, including but not limited to the Export Administration Regulations
("EAR"), and sanctions regimes of the U.S. Department of Treasury, Office of Foreign Asset Controls. Reseller will comply
with these laws and regulations. Reseller shall not, without prior U.S. government authorization, sell, export, re-export, or
transfer any goods, software, or technology subject to this Agreement, either directly or indirectly, to any country subject to
a U.S. trade embargo or to any resident or national of any such country, or to any person or entity listed on the "Entity List"
or "Denied Persons List" maintained by the U.S. Department of Commerce or the list of "Specifically Designated Nationals
and Blocked Persons" maintained by the U.S. Department of Treasury. In addition, any goods, software or technology
subject to this Agreement may not be sold, exported, re-exported, or transferred to an end-user engaged in activities
related to weapons of mass destruction. Such activities include but are not necessarily limited to activities related to:
(1) the design, development, production, or use of nuclear materials, nuclear facilities, or nuclear weapons;
(2) the design,
development, production, or use of missiles or support of missiles projects; (3) the design, development, production, or use
of chemical or biological weapons.
ATTENTION: All payments must match the name on the invoice.
We DO NOT accept third party wire transfers nor payments.
When paying by check, name on check must match name on the invoice.
All customers will be checked against the OFAC database (Office of Foreign Assets Control)
and periodically
rechecked against updated lists.
Any change of Ownership must be noted in writing within (5) business days.
Any change of address must be noted in writing within (5) business days.
You are advised we have an annual review of the above items.
We will expect your cooperation in providing
updated information annually.
Date
PRINT NAME
Title
RESALE INFORMATION (Official Resale Certificate Copy Required) -(if applicable)
Firm Name
I HEREBY CERTIFY: That I hold a valid seller's permit #
Permit #
issued pursuant to the Sales and Use
Tax law;
that I am engaged in the business of selling
selling
that the tangible personal property described herein which I shall purchase from Techstar Electronics Inc., will be resold by me in the
form of tangible property; PROVIDED, however, that in the event any such property is used for any purpose other than retention,
demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and
Use Tax Law to report and pay for the tax, measured by the purchase price of such property.
Description of property to be purchased:
Description
Date
Location
Name
CERTIFICATE OF COMPLIANCE WITH U.S. ANTI-MONEY LAUNDERING LAWS
It is Company policy to fully and strictly comply with U.S. anti-money laundering laws, including the U.S. Bank Secrecy Act and the U.S.
Patriot Act, in connection with any payment for goods or services purchased from Company.
• Customer certifies that as a condition of doing business with Techstar Electronics Inc. that it (and all of its employees and agents)
shall comply with all U.S. anti-money laundering laws, including the U.S. Bank Secrecy Act and the U.S. Patriot Act in connection with
any payment or transfer of funds for goods and services.
• Customer certifies that any payment or transfer of funds to Company for goods or services to Company is not in violation of US or
foreign currency laws.
• Customer certifies that it has received, understood, and agrees to fully comply with the attached Statement of Corporate Policy and
Notice of Compliance with AML Laws in connection with any transaction, transfer, deposit, advance, or payment for goods or services
provided by Company.
• Customer agrees that it shall not make any direct deposit of funds into Company's account in cash or any form of cash equivalent
(e.g., personal check, cashier's check, certified check, Western Union, Moneygram, AMEX/ traveler's check).
• Customer agrees to strictly follow Techstar Electronics' policies and procedures in remitting payment. Any change in payment
method must be approved in writing by Techstar Electronics before any order is fulfilled; noncompliance shall result in delay or
cancelation of any pending transaction.
• Customer agrees not to make any payment or transfer of funds for goods or services or other deposit into Company's account by
means of any third party facility including exchange house or casas de cambio.
• Customer must obtain pre-approval of Techstar Electronics to accept payment from a third party payor on the Techstar Electronics'
Approved List. Transactions will be canceled or delayed for noncompliance or completion of required documentation. Customer
agrees to rescind any transaction where written pre-approval is not obtained from Techstar Electronics' Credit Department and to
pay for any such transaction through approved methods only.
• Customer acknowledges and agrees that payment by any means except as pre-approved is subject to rejection by Techstar
Electronics in its sole discretion, and that Techstar Electronics may file appropriate reports of such transactions with the US Dept. of
the Treasury and other governmental agencies.
Customer agrees to provide all information and to execute all documents as may be necessary or required by Company to document
compliance with U.S. anti-money laundering laws. This includes but is not limited to the third party payment forms attached hereto for
international/domestic transactions.
Agreed: Company Name
Date
Print Name Authorized Company Official
Title
Signature
Send
