Credit Application | credit.riemer.com

Business Information

Legal Business Name

Parent Company Name

Business Type

Doing Business As (DBA)

Federal ID / Canada BIN #

Duns #

Date Business Established

Years Under Current Ownership

#years

Telephone

Website

Company Type

Corporation

LLC

Sole Proprietorship

Partnership

Government Agency

Date of Incorporation

State of Incorporation

Credit Line Requested

Resale Certificates

To claim resale tax exemption, please select the states you will receive and sell our goods in and complete the following section(s):(Delaware and New Hampshire are excluded because they do not require sales tax.)


Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Florida
Georgia


Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland


Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Jersey
New Mexico


New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina


South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

Louisiana Resale Certificate

REQUIRED: Include the resale certificate for Louisiana:

1. Click HERE to access your state resale certificate.
2. Print the document
3. Sign and scan it to your computer
4. Upload to this application:

Upload requirements

Mississippi Sales Tax License or Permit

Please upload a copy of your Mississippi Sales Tax License or Permit

Upload requirements

Multijurisdiction Resale Certificate Form

Description of goods or services to be purchased

Purchaser engaged or is registered as a

Wholesaler

Retailer

Manufacturer

Seller

Lessor

Other

Specify

Enter State Registration Information

State	ID (your state identification number)
Alabama
Alaska/ARSSTC
Arizona
California
Colorado
Connecticut
Florida
Hawaii
Idaho

State	ID (your state identification number)
Illinois
Maine
Maryland
Missouri
New Mexico
Pennsylvania
South Carolina
Texas

Streamlined Resale Certificate Form

Single Purchase

Check if this certificate is for a single purchase

Purchase Order Number

Enter the related invoice/purchase order #

Enter State Registration Information

Identification (ID) number: Enter the ID number as required in the instructions for each state in which you are claiming an exemption.

Reason: If claiming multiple exemption reasons, enter the letters identifying each reason as listed in "Reasons for exemption" (above) for each state.

State/Country: Identify the state or if a foreign ID, the country the ID number is from.

State	ID (your state identification number)	Reason	State/Country
Arkansas
Georgia
Iowa
Indiana
Kansas
Kentucky
Michigan
Minnesota
North Carolina
North Dakota
Nebraska
New Jersey

State	ID (your state identification number)	Reason	State/Country
Nevada
Ohio
Oklahoma
Rhode Island
South Dakota
Tennessee
Utah
Vermont
Washington
Wisconsin
West Virginia
Wyoming

ID Numbers for Exemptions other than resale: You are responsible for ensuring that you are eligible for the exemption in the state you are claiming the tax exemption. Provide the ID number to claim exemption from sales tax that is required by the taxing state. Check with that state to determine your exemption requirements and status.

Foreign diplomats and consular personnel must enter their individual tax identification number shown on their sales tax exemption card issued by the United States Department of State's Office of Foreign Missions.

ID Numbers for Resale Purchases (Including Drop Shipments): If you are claiming a purchase is not subject to tax because it is for resale and you are:

1. Required to be registered in the state you are claiming the tax exemption: Provide your sales tax ID number issued by that state. If claiming exemption in OH and registration is not required in the state, enter any tax ID number issued by OH. If claiming exemption in MI and registration is not required in the state, enter “Not Required”.

2. Not registered in the state you are claiming the tax exemption: Provide your sales tax ID number issued by any state.

3. Not required to register for sales tax and you do not have a sales tax identification number from any state: Enter

Your FEIN.
If you do not have a FEIN, enter a different state‐issued business ID number.
If you do not have any state‐issued business ID number or FEIN, enter your state driver's license number.

4. A foreign purchaser and you do not have an ID number described in 1, 2 or 3: The following states will accept the tax ID number (e.g., VAT number) issued by your country: AR, IN, KS, KY, ND, NJ, OK, RI, SD, TN, UT, WA, WY. All other states require an ID number as listed in 1, 2 or 3.

If you do not have any of the ID numbers listed in 1 thru 4: You are not required to list an ID number for the following states: NE, OH, SD, WI. Enter "Not Required" and the reason for exemption for that state. All other states require an ID number.

Oregon Resale Certificate Form

This business’ only physical location is in Oregon.

Yes

No

Oregon Business Registry Number:

Description of goods or services to be purchased:

This business is engaged in selling the following type of tangible property:

Montana Resale Certificate Form

This business’ only physical location is in Montana.

Yes

No

Montana Business Registration Number:

Description of goods or services to be purchased:

This business is engaged in selling the following type of tangible property:

Virginia Resale Certificate Form

The undersigned dealer hereby certifies that all tangible personal property purchased from the above named supplier on and after this date will be purchased for the purpose indicated below, unless otherwise specified on each order, and that this Certificate shall remain in effect until revoked in writing by the Department of Taxation. Check proper box below.

Tangible personal property for RESALE only. Do not use to purchase cigarettes for resale.

Tangible personal property for future use by a person for taxable LEASE OR RENTAL as an established business, or part of an established business, or incidental or germane to such business, or a simultaneous purchase and taxable leaseback. This sales and use tax exemption is not applicable to long-term leases of motor vehicles when lease payments charged to customers are not subject to the motor vehicle sales and use tax.

Packaging materials such as containers, labels, sacks, cans, boxes, drums or bags that are marketed with a product being sold and become property of the purchaser.

Virginia Account Number

Trading as Name

Kind of business engaged in by dealer

Massachusetts Resale Certificate Form

Certificate Type

Single Purchase Certificate

Blanket Certificate

Type of business in which purchaser is engaged

Description of goods or services to be purchased

District of Columbia Resale Certificate Form

Purchaser Trade Name (if any)

DC SALES AND USE TAX ACCOUNT ID NUMBER

Bank Reference

Bank Information

Bank Name

Telephone

Fax Number

Contact Officer Name

Email

Date Account Opened

Bank Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Financial Information

Upload most recent financial statements

Upload requirements

Trade References

Reference Information

Company/Vendor Name

Account # at this company

Telephone

Email Address

Address

Country

Street address

City

State

Zip code

Reference #2

Reference Information

Company/Vendor Name

Account # at this company

Telephone

Email Address

Add another reference?

Yes

No

Address

Country

Street address

City

State

Zip code

Terms and Conditions / Dealer Agreement

The information provided by the applicant (hereinafter, “CUSTOMER”) is for the purpose of establishing a commercial credit account with Sheltered Wings, Inc. d/b/a Vortex Optics (hereinafter, “VTX”). CUSTOMER desires to purchase goods and / or services from VTX, and CUSTOMER agrees, in consideration thereof, to be bound by VTX’s Terms and Conditions set forth in Dealer/Sales. VTX hereby objects to any terms or conditions at variance with, dierent from or in addition to VTX’s Terms and Conditions of Dealer/Sales. CUSTOMER further agrees to the following terms:

1. OPEN CREDIT ACCOUNT: VTX reserves the right to approve or disapprove any request for extension of credit at its sole discretion. The amount of credit extended to CUSTOMER will be determined by VTX and may vary from time to time. CUSTOMER waives notice of any change in CUSTOMER’S credit limit. CUSTOMER agrees to below payment terms of any and all invoices, charges, fees and costs incurred on CUSTOMER’S account.

2. OPEN ACCOUNT PAYMENT TERMS: VTX’s credit terms for CUSTOMER are Net 30 days from the invoice date. These are the only payment terms oered by VTX to CUSTOMER unless modified in writing and signed by a VTX ocer or authorized manager.

3. CUSTOMER’S REPRESENTATIONS: Credit will be extended by VORTEX to CUSTOMER based on the information provided in this Credit Application and Agreement. CUSTOMER represents and warrants to VTX that all information and / or financial documents provided VTX are true and correct. CUSTOMER represents to VTX that it is solvent as of the date of this Credit Application and Agreement, and that any financial statement attached accurately reflects the present financial condition of the CUSTOMER. CUSTOMER expressly authorizes VTX to check CUSTOMER’S credit background. This may include obtaining a credit report from a credit reporting agency, requesting information from your bank, or inquiring directly with your creditors.

4. DEFAULT: Failure to make timely payment as provided above shall result in the account being deemed past due. Whether or not expressed in any quotation or invoice, the CUSTOMER agrees to reimburse VTX for all collection agency fees, expenses, costs, and attorney’s fees (including in-house counsel fees) incurred or expended by VTX in enforcing any of its rights hereunder and / or collecting any past due sums.

5. GOVERNING LAW AND VENUE: This agreement shall be governed by and construed in accordance with the laws of the State of Wisconsin without regard to the conflicts of law principles thereof.

6. ENTIRE AGREEMENT: This Agreement represents the entire understanding of the Parties with respect to the subject matter hereof, and supersedes all prior agreements, written or oral, between the Parties relative thereto. This Agreement may not be amended except in writing and signed by both Parties, and no right or objection hereunder may be waived except in writing signed by the waiving Party.

7. INVALIDITY: If any provision of this Agreement is found to violate any statue, rule, regulation, order or decree of any governmental authority, court, agency, or securities exchange, such invalidity shall not be deemed to aect any other provision hereof or the validity of the remainder of this Agreement, and such invalid provision shall be deemed deleted from this Agreement to the minimum extent necessary to cure such violation.

8. SUCCESSORS AND ASSIGNS: This agreement is for the benefit of the Parties and their respective directors, ocers, employees, representatives, agents and their respective successors and assigns.

9. TAX EXEMPTION STATUS: CUSTOMER will be charged sales and use tax unless valid tax exemption certificate is provided to VTX. Exemption certificates must be valid for CUSTOMER making purchases from VTX.

ACKNOWLEDGEMENT: The undersigned hereby warrants and represents (i) that he or she is a duly authorized representative of the CUSTOMER with full legal authority to bind the same by the execution of this Application and (ii) that the information set forth in this Application is provided for the purpose of obtaining credit from VTX and is true and correct. The undersigned hereby acknowledges and agrees (III) that eective upon any acceptance by VTX of this Application, all sales of goods or services to CUSTOMER will governed by VTX’s standard terms and conditions of Dealer/Sales and as the same may be modified from time to time and (iv) that VTX’s provision of credit for the supply of goods and services shall constitute fair and sucient consideration in exchange for the applicability

of such standard terms and conditions of sale.
Signature ____________________________________ Print Name _____________________________________________ Date ____________________________

PERSONAL GUARANTEE: In consideration of VTX’s extending credit to CUSTOMER, the undersigned (hereinafter, “GUARANTOR”) unconditionally and irrevocably guarantees and promises to pay to VTX, any and all indebtedness and perform all obligations of CUSTOMER to VTX. GUARANTOR waives notice of the following: (i) acceptance of this guarantee by VTX; (ii) creation of any debt or obligation on the party of CUSTOMER to VTX; (iii) default by CUSTOMER on any obligations owing to VTX; and (iv) presentment, protest and demand and / or notice of presentment, protest and demand. GUARANTOR agrees that VTX may, with aecting GUARANTOR’S liability, compromise or release, and grant extensions of time of payment to CUSTOMER. GUARANTOR shall pay all attorney’s fees and costs incurred by VTX in the enforcement of this guarantee. This guarantee shall continue in force until revoked by GUARANTOR in writing transmitted by certified mail return receipt requested to: Sheltered Wings, Inc., d/b/a Vortex Optics, 1 Vortex Drive, Barneveld, WI 53507. Revocation shall be eective sixty days after receipt by VTX. Revocation shall not terminate or otherwise aect any obligations of GUARANTOR existing on or accrued prior to the eective date of revocation and shall not aect any rights or obligations arising out

of transactions having their inception prior to the eective date of revocation.
Signature ____________________________________ Print Name _____________________________________________ Date ____________________________

I have read and accept these policies

View/Download Terms & Conditions Here

Applicants Signature

Business Name

Signature Authority's Printed Name

Signature Authority's Title

The undersigned certifies that he/she is authorized to execute this document and that all statements are true and correct.

Applicants Signature

Sign above

The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age; (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580

PERSONAL GUARANTEE

I hereby personally guarantee to you the payment of any obligation of the Company and I hereby agree to bind myself to pay you on demand any sum that may become due to you by the Company whenever the Company shall fail to pay the same. It is understood that this guarantee shall be a continuing and irrevocable guaranty and indemnity for such indebtedness of the Company. I do hereby waive notice of default, nonpayment and notice thereof and consent to any modifications or renewal of the credit agreement hereby guaranteed.

I have read and accept the personal guarantee

Personal Guarantee Signature

Business Name

Signature Authority's Printed Name

Signature Authority's Title

The undersigned certifies that he/she is authorized to execute this document and that all statements are true and correct.

Personal Guarantee Signature

Sign above

The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age; (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580

Applicant Email

Enter your email and a copy of your submission will be sent to you