212-645-5600

Fax: 212-645-6561

Web Site: Http://www.tball.com

NEW DEALER APPLICATION AGREEMENT

Shipping Address:

Your Company Name:

Address:

Billing Address:

State:

City:

Zip:

State:

City:

Zip:

Phone:

Fax:

Phone:

Fax:

E-mail:

E-mail address:

Website:

Contact:

State Resale Certificate#:

Date of issue?

Federal Employer Identification#:

Name of Accounts Payable Manager:

Company is:

Partnership

Sole Proprietorship

Corporation

If corporation, what is the date of incorporation?

States in which applicant does business:

Date business was started:

Trade References

Ownership Information:

Supplier Account#

1) Supplier:

1) Title:

Contact:

First Name:

Middle:

Last:

Street Address:

State

City:

Zip:

Street Address:

State:

City:

Zip:

Phone:

Fax:

Social Security#:

Phone:

Supplier Account#

2) Supplier:

2) Title

Contact:

First Name:

Middle:

Last:

Street Address:

Street Address:

State

City:

Zip:

State:

City:

Zip:

Phone:

Fax:

Social Security#:

Phone:

(If you require more space, please attach separate page..)
Bank reference information:

ACCEPTED THUNDERBALL MARKETING, INC.

By:

Title:

Bank Account Number:

Date:

Bank:

Contact:

Your New Account Representative:

Street Address:

I do certify that the information contained on this application is true and accurate

State:

City:

Zip:

Phone:

Fax:

Signature (''Buyer'')

Title

Date

Please forward this information immediately to:

Signature (''Buyer'')

Title

Date

New Accounts Dept.

Thunderball Marketing Inc.
10 Cragwood RD.
Avenel, NJ 07001

Phone: (212) 645-5600
Fax: (212) 645-6561