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Name*
First Last
Company Name
Title
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone

Customer Credit Application

Please provide company information, bank reference information, and four trade references.

Step 1 of 6

Company Information
Company Name*
Doing Business As (DBA)
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Contact*
First Last
Phone
Email
Primary Contact Position/Title*
Shipping Address
If different from Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Business*
- Proprietorship
- Partnership
- Corporation
Federal Tax Payer ID No.
Year Business Established*
Please enter a number from 0000 to 9999.
Resale No.
Attachments
Without a copy of your Tax Exemption Certificate your Customer Credit Application cannot be processed. You must attach a copy to continue with this form. Please attach below as a jpg, pdf, tif, png, or similar file type.
Tax Exemption Certificate
Maximum file(s) size = 20MB.
Accepted file types: jpg, txt, gif, png, pdf, tif, ai, psd, zip, eps, doc, docx, Max. file size: 20 MB.
Do you have a Resale Certificate for your state?*
- Yes
- No
- Not applicable
Resale Certificate*
Please follow all rules according to your state when submitting valid Resale Certificates. Maximum file(s) size = 20MB.
Accepted file types: jpg, txt, gif, png, pdf, tif, ai, psd, zip, eps, doc, docx, Max. file size: 20 MB.

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Bank Reference
Bank Name*
Account No.*
Bank Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank Contact
First Last
Bank Phone*
Bank Fax*

Save and Continue Later

Trade Reference #1
Reference #1 Company Name*
Reference #1 Phone*
Reference #1 Email*
Reference #1 Fax
Reference #1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Save and Continue Later

Trade Reference #2
Reference #2 Company Name*
Reference #2 Phone*
Reference #2 Email*
Reference #2 Fax
Reference #2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Save and Continue Later

Trade Reference #3
Reference #3 Company Name*
Reference #3 Phone*
Reference #3 Email*
Reference #3 Fax
Reference #3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Save and Continue Later

Trade Reference #4
Reference #4 Company Name*
Reference #4 Phone*
Reference #4 Email*
Reference #4 Fax
Reference #4 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Save and Continue Later

Credit Reference

Credit Referral
Please complete this form so we may determine the credit worthiness of this applicant.
Your Company Information
Company Name:*
Name*
First Middle Last
Referral information
Sold Since:
High Credit:
Date of Last Sale:

Example: 01/01/2019
A/R Balance:
A/R Info:
Current
1 of 4
1-30 days
2 of 4
31-60 days
3 of 4
Over 90
4 of 4
Total A/R
Sum of the last 4 questions
Terms
Percent:
Please enter a number from 0 to 100.
Days:
Net:
Discount:
Average Days to Pay:
Prompt:
Slow:
NSF Checks:
Comments
Add additional comments here...

Online Seller Request

Name*
First Last
Title*
Business Name*
Phone*
Website*
Email*
Where do you plan to sell?*
(Select one or both)
- Online (e.g. your website)
- Marketplaces (e.g. your eBay)

Buyer Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Purchase Information
Item Purchased*
Please enter the part number(s) you purchased.
Date Purchased*
MM
DD
YYYY
Where did you make your purchase*
Installation Information
Vehicle Year*
Vehicle Make*
Vehicle Model*
Additional Information
Comments
Attachment
Upload your Proof of Purchase*
This can be a receipt, screenshot, email, or other proof showing your product and the place of purchase.
Drop files here or

Max. file size: 20 MB.

Step 1 of 4

Your Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Purchase Information

Item(s) Purchased*

Date Purchased*

Where did you make your purchase?*

Vehicle Information

Year*

Make*

Model*

Drivetrain*

Is the vehicle on which the product is installed used for commercial purposes?

Yes

No

What is the defect in the product?*

What is your preferred contact method?*

Phone

Email

Do you own the vehicle in which the product is installed?*

Yes

No

Has the product ever been in stalled on another vehicle?*

Yes

No

Upload image of the damaged item(s)*

Max. file size: 20 MB.

Upload your proof of purchase*

Max. file size: 20 MB.

Step 1 of 4

Your Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Purchase Information

Item(s) Purchased*

Date Purchased*

Where did you make your purchase?*

Vehicle Information

Year*

Make*

Model*

Drivetrain*

What is the reason for this return?*

What is your preferred contact method?*

Phone

Email

Do you own the vehicle in which the product is installed?*

Yes

No

Has the product ever been in stalled on another vehicle?*

Yes

No

Upload your proof of purchase*

Max. file size: 20 MB.

JENI CHEN
Director of Operations
805.698.1608
[email protected]

SKY PADGETT
Director of Sales
402.709.7155
[email protected]

RYAN DOUGAN
Controller
805.901.2787
[email protected]

JUSTIN TEVIS
Director of Data & Tech Ops
805.696.5521
[email protected]

TOM BATEMAN
Director of Marketing
208.512.0855
[email protected]

GERRY LAMBERTI
Chairman & CEO
805.453.2726
[email protected]

ADAM WEISNER
Chief Commercial Officer
208.449.9506
[email protected]

Schedule A Training

Brand Protection continues to be of the utmost importance for our company and our customers. We’ve spent the last several years building and rolling out processes to that end.

With that in mind, effective immediately, we’ve added Amazon to our Do Not Sell list.

Please make sure you frequently review the Authorized and Unauthorized Sellers on below to ensure your adherence to our Brand Protection Program. Selling to an Unauthorized Seller violates that program.

If you have any questions concerning selling online, please contact your relationship manager at 800.898.0705.

Thank you for your partnership and continued support of the SuperSprings International brand.

Company Name*
What type of customers do you work with?*
What type(s) of vehicles do you install products on?*
(check all that apply)
- Select All
- Recreational truck/car
- Commercial vehicles
- RV/Van/Motorhomes
- Trailer/Towables
- Jeep
- Overland
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Website*

The event is finished.

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YOUR ITEMS

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Company Information

Attachments

Bank Reference

Trade Reference #1

Trade Reference #2

Trade Reference #3

Trade Reference #4

Credit Referral

Your Company Information

Referral information

A/R Info:

Terms

Comments

Buyer Information

Purchase Information

Installation Information

Additional Information

Attachment

Your Information

Purchase Information

Vehicle Information

Your Information

Purchase Information

Vehicle Information

Test

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