Protect-A-Bed / SureFit New Dealer Application (NET 30)
Dear New Dealer,
We appreciate your business and look forward to a long lasting relationship as your supplier. For your convenience, only the fields marked with asterisks (*) are required. For assistance with this application please contact your Protect-A-Bed / SureFit sales representative.
Primary Company Contact
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Fax
-
Area Code
Phone Number
Company Information
Legal Business Name
*
Trade Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax
-
Area Code
Phone Number
Names of Proprietors, Partners, or Officers/Titles
Accounts Payable Contact
First Name
Last Name
Accounts Payable E-Mail
example@example.com
Accounts Payable Phone
-
Area Code
Phone Number
DUNS #
Dun and Bradstreet (D&B) (9 digits)
FEIN #
Federal Employer Identification Number (9 digits)
Years in Business
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Shipping Information
More than one ship-to location?
*
No
Yes
For more than 1 location please contact your Protect-A-Bed/Surefit Sales Representative for assistance.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Warehouse / Shipping Contact
First Name
Last Name
Warehouse / Shipping Contact E-Mail
example@example.com
Warehouse / Shipping Contact Phone
-
Area Code
Phone Number
Please indicate here any times you CANNOT receive deliveries.
Do you have an inbound routing guide?
*
No
Yes (Please upload below)
Inbound Routing Guide
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Do you require an appointment for delivery?
*
No
Yes (Please indicate in the additional information field below)
Do you require a lift gate for delivery?
*
No
Yes (Will incur an additional charge)
Lift Gate Policy Acknowledgement (Please initial)
Please indicate any additional information or special requirements for deliveries. (Optional)
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Retail Information
What is your most dominant channel?
*
Furniture
Mattress
Linens
Appliances
Rent-to-Own
Hospitality
Other
Do you want to be listed as an authorized dealer on Protectabed.com's store locator?
*
Yes
No
Buying Group Affiliation (Select all that apply)
*
AVB/Brandsource
Nationwide Marketing Group
Furniture Marketing Group (FMG)
Ashley Homestores
America's Mattress
TRIB
Other
No buying group affiliation
PREFERRED Buying Group Identification Number
What is your retail website address(es)?
*
Please upload your tax exemption certificate.
*
Browse Files
If you conduct business in multiple states please contact your Protect-A-Bed/SureFit sales representative for assistance.
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Credit Application
Name of bank where your business banking is conducted
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Account Number
*
Business Banker
*
First Name
Last Name
Business Banker contact info (phone, e-mail, fax, branch name, etc.)
*
Has this business ever been involved in bankruptcy proceedings?
*
No
Yes
Credit Reference #1
*
Company Name
Account Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax
*
-
Area Code
Phone Number
Contact/Rep Name
*
First Name
Last Name
Contact/Rep E-Mail
example@example.com
Credit Reference #2
*
Company Name
Account Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax
*
-
Area Code
Phone Number
Contact/Rep Name
*
First Name
Last Name
Contact/Rep E-Mail
example@example.com
Credit Reference #3
*
Company Name
Account Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax
*
-
Area Code
Phone Number
Contact/Rep Name
*
First Name
Last Name
Contact/Rep E-Mail
*
example@example.com
Estimated Monthly Purchases
*
$0-$500
$500-$1,000
$1,000-$2,500
$2,500-$5,000
$5,000-$10,000
$10,000-$50,000
$50,000+
Estimating your monthly purchases will assist in determining credit limit.
PLEASE SIGN AND DATE! General Provisions: This application and the information contained herein is a request for extension of credit for commercial business use only. The applicant authorizes the above named creditor to obtain a written or oral credit report from any credit-reporting agency. The applicant further authorizes any bank or commercial business with which the applicant is doing or has done business to give any and all necessary information to the creditor. The applicant further authorizes the creditor to re-investigate the applicant’s credit status, as the creditor deems necessary. Application must be signed to be processed. If credit is extended, the applicant agrees to pay all debts incurred within the terms of sale. However, should the debt become past due, the applicant expressly agrees to pay finance charges on the past due amounts provided that no provision of this agreement requires or permits the collection of finance charge in excess of the maximum amount permitted by law. The applicant further expressly agrees to pay reasonable collection costs and/or attorneys’ fees incurred in connection with the collection of this account.
*
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MAP Policy Acknowledgement
I, Protect-A-Bed Customer, acknowledge that I have received this copy of Protect-A-Bed’s Minimum Advertised Price (“MAP”) Policy, as well as its MAP advertising guidelines and other MAP information, which was unilaterally adopted and is uniformly enforced by Protect-A-Bed. Protect-A-Bed Customer represents and warrants that it has read and understood the attached MAP Policy, the MAP advertising guidelines and other information. The MAP Policy and the MAP advertising guidelines are for advertised prices only and do NOT apply to actual resale prices which, are set unilaterally by Protect-A-Bed Customer. No employee or representative of PAB has any authority to tell Protect-A-Bed Customer what its prices must be or to inhibit in any way Protect-A-Bed Customer’s independent pricing decisions. Protect-A-Bed Customer acknowledges that Protect-A-Bed enforces its MAP Policy, and will impose penalties up to and including termination for violation of the MAP Policy. MAP is subject to change. At the time of signing, the current MAP may be referenced as shown on Protect-A-Bed Price/Order Forms effective January 1st, 2019.
I agree to the aforementioned MAP Policy. (Please sign and date)
*
Online/E-Commerce Policy
I, Protect-A-Bed Customer, will only sell Protect-A-Bed products in our brick and mortar location(s) and on our own websites as detailed below. Protect-A-Bed does not allow sales or pass-through sales on any online/E-commerce marketplaces, including but not limited to: Amazon, Alibaba, Jet, Rakuten, Ebay, Overstock, Buy.com, Walmart Marketplace, Sears Marketplace. If I, Protect-A-Bed Customer, choose to sell Protect-A-Bed products online on our own websites: 1. All images, logos and other branding remains the property of Protect-A-Bed. 2. Protect-A-Bed reserves the right to review published content and request changes. 3. All use of Protect-A-Bed’s logos and images must comply with Protect-A-Bed’s brand guidelines.
Protect-A-Bed Customer wishes to sell Protect-A-Bed products on the following websites, which Protect-A-Bed Customer represents is/are not online marketplace(s. If you do not wish to sell Protect-A-Bed products on any websites, please indicate "NA"):
*
I agree to the aforementioned Online/E-Commerce Policy. (Please sign and date)
*
Intellectual Property Acknowledgement
I, Protect-A-Bed Customer, acknowledge the ownership by Protect-A-Bed of its trademarks and trade names (“Protect-A-Bed Marks”), and patent US 7,552,489 B2 (“BugLock Patent”) (collectively the “PAB Intellectual Property”), and agrees that (i) nothing herein shall give Protect-A-Bed Customer any right, title or interest in either the Protect-A-Bed Marks or the BugLock Patent, (ii) that each and every part of the PAB Intellectual Property are, and is to be, the property of Protect-A-Bed, and was fully developed by Protect-A-Bed and (iii) that any and all use by Protect-A-Bed Customer of the PAB Intellectual Property and the goodwill arising there from shall inure to the benefit of Protect-A-Bed.If Protect-A-Bed Customer discovers any infringement by anybody of the PAB Intellectual Property, Protect-A-Bed Customer shall communicate the details to Protect-A-Bed.Protect-A-Bed Customer shall cooperate fully with Protect-A-Bed in the defense and protection of the PAB Intellectual Property, and agrees to notify Protect-A-Bed of any adverse use of marks identical with or confusingly similar to the PAB Intellectual Property, which come to Protect-A-Bed Customer’s attention, or any other activity which Protect-A-Bed Customer reasonably determines may implicate the rights included in the PAB Intellectual Property. Decisions involving the protection and defense of the PAB Intellectual Property, and the costs of doing so, shall be solely the responsibility of and in the discretion of Protect-A-Bed.
I agree to the aforementioned Intellectual Property Policy. (Please sign and date)
*
Submit
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