Please Remember to Fax or Mail to the Following:
24350 N. 20th
Building C, Suite 134
Phoenix, Arizona 85085
FAX 877-799-9048
Important! All items marked with an (∗) must be completed and faxed back.
*Wholesale Account Application (Page 2)
∗Signed Blanket Sales Tax Exemption Certificate (Page 3)
∗A Copy of your State Sales Tax Form (State Registration Number)
“Not Town, City, County, or Federal”
Please Note: If There are any questions regarding the application, Please Call
Direct Performance at 1-(800) 938-3456
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED
Confidential
Page 1
WHOLESALE ACCOUNT APPLICATION
***THIS FORM IS REQUIRED FOR PROCESSING***
24350 N. 20th Drive
Building C, Suite 134
Phoenix, Arizona 85085
PHONE 800-938-3456 FAX 877-799-9048
Please allow 24 to 48 hours to process your account.
Your Assigned Agents Name
Please complete legibly as to avoid any errors when processing your account.
Company’s Full Legal Name: _______________________________________________Contact Name:___________________________________
DBA: ________________________________________________________________ Phone #: ________________________________________
Type of Business:________________________________________________________ State of Organization: ____________________________
Parent Company: _______________________________________________________ Phone #: ________________________________________
Parent Company Address: _________________________________________________________________________________________________
Mailing Address: ________________________________________________________________________________________________________
City: ________________________________________________
State: ___________________________
Zip: ________________________
Shipping Address (must be a physical address): ______________________________________________________________________________
City: ________________________________________________
State: ___________________________
Zip: ________________________
Number of Years in Business: ____________________________
Estimated Monthly Purchases: ____________________________
*State Sales Tax # (State Registration Number)
Number of Commercial Fleet Vehicles:
Purchasing Contact:
Phone #:
Fax #:
E-Mail
Comments:
Do you have an order pending with directperformance.com now? YES
(or) NO
Are you a member of the Automotive Services Association?
YES
(or) NO
Interested in becoming a recommended installer?
YES
(or) NO
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED
Confidential
Page 2
BLANKET SALES TAX EXEMPTION CERTIFICATE
***THIS FORM IS REQUIRED FOR PROCESSING***
Issued to (Seller) Direct Performance.com 20225 N. Scottsdale Dept. #500, Scottsdale, AZ. 85255
Name of Firm (Purchaser):
I Certify
that:
Phone #
Address:
City,
State,
Zip:
is a registered with the state of ______________________ within which your firm would deliver purchases to us and that any such
purchases are for:
Reason for Purchase
Is Engaged as a Registered
Purchased for Resale
Incorporated as an ingredient or component part of new product manufactured for resale
Purchased for Leasing
Purchased for farm use (on off-road vehicle only)
Charitable or religious organizations and government entities
Wholesaler
Retailer
Manufacturer
Lessor
We are in the business of wholesale, retailing, manufacturing, leasing the following:
I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax,
we will pay the tax due direct to the proper taxing authority when state law so provides or inform the seller for added tax billing. This
certificate shall be part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until cancelled
by us in writing or revoked by the city or state.
General description of products to be purchased from the seller:
Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.
Authorized Signature (Owner, Partner or Corporate Officer)
Title
Date
Printed Name of Person Signing Form
State Registration Number
Local Registration Number, if Applicable
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED
Confidential
Page 3