Credit Application (pdf) - QLogic

(PLEASE COMPLETE BOTH PAGES)
CREDIT
APPLICATION
LEGAL BUSINESS NAME
DBA
BILLING ADDRESS
CITY
STATE COUNTRY POSTAL CODE
PRESIDENT
TREASURER
NAME OF PRINCIPALS OF FIRM
VICE PRESIDENT
CONTROLLER
LIMITED PARTNERSHIP
SUBSIDIARY OF
CORPORATION GENERAL PARTNERSHIP SOLE OWNERSHIP DIVISION OF
PARENT COMPANY
DOES PARENT COMPANY GUARANTEE DEBITS
YES
NO
ADDRESS STATE COUNTRY ZIP
TYPE OF BUSINESS NUMBER OF EMPLOYEES BUSINESS PHONE BUSINESS FAX
( ) ( )
A/P CONTACT A/P CONTACT PHONE A/P CONTACT EMAIL ADDRESS
( )
PURCHASING AGENT PURCHASING PHONE PURCHASING AGENT EMAIL ADDRESS
( )
CREDIT LINE DESIRED D-U-N-S Number ANNUAL COMPANY SALES
IS MERCHANDISE FOR SALE (See Resale Information on Reverse Side)
QLOGIC SALES REPRESENTATIVE
Yes
No
CUSTOMER VAT NUMBER (EU CUSTOMERS)
CUSTOMER VAT EXEMPTION NUMBER (IRELAND ONLY)
TRADE REFERENCES
( l d b (Only f provide companies ) you buy from on open account)
COMPANY NAME PHONE FAX ACCOUNT NO.
( ) ( )
ADDRESS CITY STATE COUNTRY ZIP
CONTACT
CONTACT EMAIL (Required)
COMPANY NAME PHONE FAX ACCOUNT NO.
( ) ( )
ADDRESS CITY STATE COUNTRY ZIP
CONTACT
CONTACT EMAIL (Required)
COMPANY NAME PHONE FAX ACCOUNT NO.
( ) ( )
ADDRESS CITY STATE COUNTRY ZIP
CONTACT
CONTACT EMAIL (Required)
IN ADDITION TO THE ABOVE, A COPY OF YOUR LATEST MONTHLY, QUARTERLY AND YEAR END FINANCIAL REPORTS ARE REQUIRED
QLogic Corporation 26650 Aliso Viejo Parkway, Aliso Viejo, CA USA 92656 Phone: 949.389.6000 Fax: 949.389.6487 www.qlogic.com
QLogic Ireland Unit 274, Blanchardstown Corporate Park 2, Ballycoolin, Dublin 15 Ireland Phone: 353.1.885.7577 Fax: 353.1.885.7591

NAME
BANK REFERENCES
(Must provide account numbers)
ADDRESS CITY STATE COUNTRY ZIP
ACCOUNT OFFICER PHONE FAX CHECKING ACCT. NO. LOAN ACCT. NO.
( ) ( )
NAME
ADDRESS CITY STATE COUNTRY ZIP
ACCOUNT OFFICER PHONE FAX CHECKING ACCT. NO. LOAN ACCT. NO.
( ) ( )
CREDIT AGREEMMENT
In reliance on the statements and representations above and on the agreement set out below, QLogic Corporation may from time to time and at its sole discretion
extend credit to the firm named in this Agreement with regard to purchases by such firm, from or through QLogic Corporation, of goods and services. Credit may
be extended on open account, by billing or invoicing, by C.O.D. terms based on any form of payment other than cash, or by any other method of credit extension.
If credit is extended, the firm named in this Agreement agrees to abide by the terms and conditions of sale and payment represented by any formal agreement with
QLogic. In the absence of a formal agreement, the firm named herein hereby agrees:
1. That the firm will pay when due, according to their terms, all bills, statements, accounts and invoices from QLogic Corporation. Any such payment
will be made to QLogic Corporation, at its offices at 26600 Aliso Viejo Parkway, Aliso Viejo, CA 92656.
2. That all past due accounts shall bear a legal rate of interest.
3. That the prevailing party in any litigation for recovery of sums due from the firm to QLogic Corporation, arising out of the firm’s purchases
(including C.O.D. purchases) from or through QLogic Corporation of any goods and services shall be entitled to recover reasonable attorney’s fees
and costs of the suit, that QLogic Corporation at its sole discretion may at any time cease further extensions of credit to the firm.
4. That both parties agree that terms of this application shall be governed by the laws of the State of California and further agree that the venue for
any action brought by creditor to enforce any terms of this agreement shall be Orange County, California.
ACCEPTED BY
(FULL NAME OF FIRM)
SIGNED
(OWNER/OFFICER SIGNATURE)
DATE
PRINTED
TITLE
RESALE/EXEMPTION CERTIFICATE
This section must only be completed by customers who will resell products purchased from QLogic Corporation.
(NOT APPLICABLE TO INTERNATIONAL CORPORATIONS NOT SUBJECT TO U.S. TAXES)
In order to meet compliance standards of the sales and use tax laws of the various states in which QLogic Corporation is doing business, we are
required to have a signed resale, direct pay, or exemption certificate in our files. To the extent that we do not have such a certificate on file, QLogic
Corporation is required by law to charge, collect and remit sales tax.
Below is a resale/exemption certificate form requesting the appropriate information. If you have your own state form, you may submit that form in lieu of
ours. A photocopy of your Seller’s Permit will not suffice under the standards of the Sales and Use Tax Laws.
Sales tax will be charged if this certificate is not completed. If your purchases from QLogic Corporation are for your own use and therefore subject to
tax, you should not complete the resale/exemption certificate.
Thank you for your cooperation in this matter. Should you have any questions, please contact the Tax Department at 949.389.6000.
FIRM NAME
I HEREBY CERTIFY,
That I hold valid seller’s permit/exemption/direct pay number
Issued pursuant to the Sales and Use Tax Law of the State of
; that I am engaged in the business of selling
That the tangible personal property described here; which I shall purchase from
RESALE INFORMATION
Will be resold by me in the form of tangible personal property; provided, however, that in the event any of such property is used for any purpose
other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by
the Sales and Use Tax Law to report and pay for the tax, measured by the purchase price of such property.
Description of property to be purchased
Dated 20 Signature
At
Phone
By and Title
Address