The Coast Distribution System

The Coast Distribution System sells to legitimate Recreational Industry (RV, Marine, Hitch) and Mobile Home dealers.

Date: _______________________ 19__________

When Business Established: ________________________ 19_____
Current Ownership Since: __________________________ 19_____
Estimated Monthly Purchases: ❑ $100 – $500 ❑ $500 – $1500 ❑ $1500 – $5000 ❑ $5000+
Firm Name: _____________________________________________________ Phone: ( ______ ) ___________________
Shipping Address:___________________________________________ City: ____________________ State: _____ ZIP: _______
Mailing Address: ____________________________________________ City: ____________________ State: ____ ZIP: _______
Type of Business: __________________________________________________ FAX: ( ______ ) _____________________
Federal Tax I.D. #: _________________________________________________
Major Recreational Industry/Mobile Home Franchise Held: ________________________________________________________
________________________________________________________________________________________________________
Ownership: ❑ Proprietor (Name): _________________________________________________ SSN: __________________
Address: ____________________________________________________ Home Phone: ( ______ )_____________
City: _______________________________________________________ State: ____ ZIP: __________________
❑ Partnership (Names – List all partners):
Name: _____________________________________________________________ SSN: ___________________
City: _____________________________________ State: ______ ZIP: _________ Home Ph.: _______________
Name: _____________________________________________________________ SSN: ___________________
City: _____________________________________ State: ______ ZIP: _________ Home Ph.: _______________
Name: _____________________________________________________________ SSN: ___________________
City: _____________________________________ State: ______ ZIP: _________ Home Ph.: _______________
❑ Corporation (Parent Company, if any): _____________________________________________________________
Officer’s Names: President: ______________________________________ SSN: ___________________
Vice Pres.:______________________________________ SSN: ___________________
Sec./Treas.:_____________________________________ SSN: ___________________
PLEASE COMPLETE ATTACHED TAX EXEMPTION CERTIFICATE OR ❑ I WILL PAY SALES TAX
IF AVAILABLE, PLEASE INCLUDE CURRENT FINANCIAL STATEMENT
Trade References: LIST ALL OPEN ACCOUNTS
Name:_____________________________________________ Phone: ( _____ )______________ Fax #: ( _____ ) _____________
Address: __________________________________________ City: _________________________ State:_____ ZIP: __________
Name:_____________________________________________ Phone: ( _____ )______________ Fax #: ( _____ ) _____________
Address: __________________________________________ City: _________________________ State:_____ ZIP: __________
Name:_____________________________________________ Phone: ( _____ )______________ Fax #: ( _____ ) _____________
Address: __________________________________________ City: _________________________ State:_____ ZIP: __________
Name:_____________________________________________ Phone: ( _____ )______________ Fax #: ( _____ ) _____________
Address: __________________________________________ City: _________________________ State:_____ ZIP: __________

Bank Reference – Business Checking

Bank Name: _______________________________________________ Acct. #: _________________________________________
Address: __________________________________________________ City: ____________________ State: ____ ZIP: ________
Phone: ( _____ )____________________________________________
TERMS REQUESTING: ❑ 2% 10 NET 30 ❑ C.O.D.
95AR002

Purchase Order Required: ❑ YES ❑ NO

To prevent possible misunderstandings, please note the following conditions of sale:

● All accounts 60 days or older are automatically C.O.D.

● No discount allowed on accounts with past due balances.
● Interest at 1.5%/month is charged on all accounts 60 days or older.
● A $15.00 charge on all NSF checks.
● Customer agrees to pay all reasonable attorney and collection fees should the account ever be referred for litigation.
● We reserve the right to suspend or terminate business transactions with any accounts more than 60 days past due.

Owner or Officer Signature: ________________________________________

Please Print or Type Name: ________________________________________

Title: _________________________________________

INDIVIDUAL PERSONAL GUARANTY

Date______________________ 19 _________

I, ____________________________________, residing at_________________________________,

for and in consideration of your extending credit at my request to ______________________________
__________________________________________________________________________________
(Your Business Name)

(hereinafter referred to as the “Company”), of which I am ____________________________________,

(Title)

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

Signature: ___________________________________

Witness: ____________________________________________

Address: ____________________________________________

_____________________________________________
 PLEASE RETURN TO:
The Coast Distribution System _______________________________________
P.O. Box 1449 OR: _______________________________________
Morgan Hill, CA 95038-1449 _______________________________________

I hereby authorize and request that you release either by phone or written request the information on our
account to the Coast Distribution System.

BANK ___________________________________________

ACCOUNT #______________________________________

DATE: _______________________________________ SIGNATURE: ______________________________

COMPANY: ___________________________________ TITLE: ___________________________________

Dear Customer:

FIRM NAME ____________________________________________________________________

We are required by the
states in which we operate
to have on file up-to-date,
SIGNED Tax Exemption
Certificates.
Please complete the
attached form, and return
with your application. If not
received within 30 days, we
will assess the appropriate
tax to any future sales.
I HEREBY CERTIFY,
That I hold valid Sellers Permit No. ______________________________________ issued on: ____________
pursuant to the Sales and Use Tax Law for the State of ___________________________________________;
that I am engaged in the business of selling: _____________________________________________________
that the tangible personal property described herein which I shall purchase from:
The Coast Distribution System/CP Products Corp./United Sales/Mohawk Trailer Sales
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: __________________________ 19 _____ Signature: ____________________________________

Address: ________________________________ Title: _________________________________________