| Sentai Customer Number ___________________________ Tax ID/Resale No ____________________ |
| Store Name _____________________________________________ Store Front ___ Mail Order/WEB ___ |
| Store Days/Hours ____________________________________________ Year Established __________ |
| Business Address _______________________________________________________________________ |
| City ____________________________________________ State/Country _____________ Zip ________ |
| Telephone (______) ____________________________ FAX (______) _____________________________ |
| Website Address ________________________________ Email Address ____________________________ |
| Type Business: Sole Prop _____ Partership _____ S-Corp _____ Corporation ______ |
| Type Acct: COD Cash ____ COD Co Chk ____ Credit Card ____ Open ____ Wire Trans ____ |
| Credit
Card : Visa ___ MasterCard ___ AMEX ___ Card Number ________________________________ Exp ________ "V"-code _____ |
| Bus Bank: ________________________________________ Acct No. _____________________________ |
| Address ______________________________________________________ Tel # (____) ______________ |
|
List names of Principals & Home Addresses (Those authorized to place orders; Use back of page if needed) |
| Name______________________________________ Name______________________________________ |
| Street______________________________________ Street______________________________________ |
| City/St/Zip_________________________________ City/St/Zip_________________________________ |
| Home Tel (_____)____________________________ Home Tel (_____)___________________________ |
| Title______________________ SSN_____________ Title____________________ SSN_______________ |
| Please list three suppliers, listing Name/address/Phone/Account Number |
| 1. ______________________________________________________________________________________ |
| 2. ______________________________________________________________________________________ |
| 3. ______________________________________________________________________________________ |
I/We have read SENTAI's Statement of Policy and agree to all conditions listed therein. IF MAIL ORDER/WEB PLEASE PROVIDE A COPY OF CURRENT CATALOG AND VERIFICATION OF A RECENT ADVERTISEMENT IN A NATIONAL HOBBY PUBLICATION OR COPY OF A YELLOW PAGES AD. CATALOG WILL NOT BE SENT UNTILL WE RECEIVE THESE VERIFYING DOCUMENTS.
SIGNATURE OF OWNER(S)_____________________________________________ DATE________________