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Poolweb Dealer Application

Thank you for your interest in becoming an authorized dealer of Poolweb, LLC/Aquatic Technology products. Please complete the following application form. Once submitted, our team will review your application and get in touch with you.

Reference #1

Company:

Contact Name:

Phone Number:

Email:

Reference #2

Company:

Contact Name:

Phone Number:

Email:

Reference #3

Company:

Contact Name:

Phone Number:

Email:

Banking Information

Bank Name:

Bank Address:

Last 4 of Account #:

Bank Contact:

Bank Phone Number:

Purchase Order Information

PO Requirements:

Authorized Purchasers:

Dealer Intentions

Anticipated Yearly Purchase Volume:

Do You Plan to Dropship Directly to Customers?:

How Will You Sell Poolweb Products:

Would you like to provide 3rd party shipping account information?

Fedex

UPS

USPS

Agreement

We (I) understand an interest charge of 1 ½% per month (18% annum) or greater when allowed by law will be applied to unpaid balances over 30 days. We (I) agree to pay all delinquency and collection charges plus reasonable attorney’s fees and court costs when allowed by law, if my account becomes delinquent. We (I) agree to all of the terms of sale listed on www.poolweb.com. No terms, provisions, or conditions of any purchase order will have any effect on the obligations of the parties or otherwise modify this Agreement. We (I) authorize Poolweb to obtain any and all credit information considered necessary to evaluate this application. We (I) understand if granted charge privileges, the terms are Invoice Due Net 30 days. We (I) certify that I have read the above statements and all information provided is accurate and submitting and providing this information is your acceptance to the terms of credit and sale. WE (I) CERTIFY THAT I AM DULY AUTHORIZED TO SUBMIT THIS APPLICATION ON BEHALF OF THE APPLICANT.

By checking this box and typing my name below, I am electronically signing my application.

Your Title:

Your Email:

Your Name:

Poolweb Dealer Application

Reference #1

Reference #2

Reference #3

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