xBIKE Dealer Application

	TOLL FREE: 1-888-275-2771 ™	CompAmericaTV 1000+ TV stations! Read about: HDX™
	Our Laptops just SELL like Hotcakes: they Don't Catch Fire™ (just 6 PCs had Warranty work in 2005!)

xBIKE™ Dealer
Application

Online Edition
xBIKE-DA-2006
 
          Be "CompAmerica Authorized"
           and empower your business

COMPAMERICA
xBIKE™ SALES DIVISION
6 Commerce Drive
Cranford, N.J. USA 07016

PHONE: 908-931-1200
http://www.compamericadirect.com

Interested in Reselling the new xBIKEs?
Apply below...

INSTRUCTIONS NOTE: for COMPUTER RESALE APPLY HERE >

Please answer all questions COMPLETELY then press the SUBMIT button at the bottom of the form. If you make a mistake, use the SHIFT-TAB key to back up to the field and re-enter it. Until you hit Submit, the form isn't sent to us. Don't worry, you can always send us another Form if you leave something out! Call the Vendor Authorizations Desk at 888-ASK-CSS1 if you have not received a reply within 7 days or have any questions.

If you prefer, or have a formless browser, you can simply E-Mail (Click Here) the information, other than your financial statements and sales tax certificate, which must be mailed/faxed...

IMPORTANT! PLEASE READ THE FOLLOWING PARAGRAPH CAREFULLY:

You must submit your company financial statements for the past two years including the current year to date and an aging report on all receivables, plus copy of or proof that you possess a State or Government Sales Tax or Business Certificate(s) of Authority. Please FAX them to 908-272-6297 or Mail them to us at:

Computer Sales & Service,
DOVCA, 6 Commerce Drive,
Cranford, NJ 07016

or your application might not be approved. If you omit your financial statements, you will be placed on Credit Card payment terms, and fees. By checking the following box marked AGREED and inserting your name, you are indicating that the information you are providing us is true and accurate, that your company is in good standing in your state and the state it was organized in, that no tax liens or outstanding litigations are to be found in your company's connection, and that you are Authorized to agree to these facts under penalty of perjury.

AGREED By (YOUR NAME:) (Date:)
on behalf of the below named company.

-- START HERE -- PLEASE ANSWER ALL QUESTIONS --

Contact Name: (Required)
E-Mail Address: (Required)	...Reconfirm by reentering a second time:
Company Name:
Phone Number:
Fax Number:

LEGAL Address:
MAILING Address:

SALES TAX ID. #:
Federal E.I.D. #:
Year & State organized:
TYPE OF ORGANIZATION Corporation, Limited Liability Corp, Partnership or Proprietership

Owner's Name(s):
Owner's Address(s):
Owner's Phone(s):
Owner's Social Sec. #:
President's Name:
Pres's Social Sec. #:
Public Company? (y/n):

Firm ever declared bankruptcy? When? (Incl. Court, Docket, Status):

Firm purchase a bankrupt? (or it's Assets, name it / address)

Has Firm had prior name(s)? (Include them)

Owner ever declared bankruptcy? (Incl. Court, Docket, Status)

Has Firm a Parent Company? (Incl. Name, Phone, TAX ID required)

Sell to Government Agencies? (Supply Name, and Contract List)
Is your business International? (y/n) (ie: owned by foreign ownership)

TYPE OF APPLICATION:

I WISH TO START A NEW BUSINESS:

AUTHORIZED xBIKE™ RESELLER BUSINESS (CANDIDATE)

AUTHORIZED xBIKE™

SERVICE PROVIDER (CANDIDATE)

AUTHORIZED xBIKE™

RESELLER AND SERVICE PROVIDER (CANDIDATE)

I ALREADY HAVE AN EXISTING RELATED BUSINESS:

BICYCLE OR ELECTRONIC BICYCLE STORE, CUSTOMIZER, OR SERVICE BUSINESS
SMALL DEPARTMENT STORE OR CHAIN
MAJOR DEPARTMENT STORE OR CHAIN
MOTORCYCLE SALES, CHOP, CUSTOMIZATION OR SERVICE BUSINESS
MOTOR VEHICLE SALES, MANUFACTURE, CUSTOMIZATION OR SERVICE BUSINESS
WEB STORE or OTHER

TYPE OF REPLY REQUIRED:

REPLY WHENEVER YOU CAN ASAP YESTERDAY!

BANK REFERENCES:

BANK REFERENCE #1 ( BANK NAME):

BANK #1 Addr.:

BANK #1 PHONE:

BANK #1 CONTACT NAME:

BANK #1 ACCOUNT NUMBER(S)/Type:

BANK REFERENCE #2 (BANK NAME):

BANK #2 Addr.:

BANK #2 PHONE:

BANK #2 CONTACT NAME:

BANK #1 ACCOUNT NUMBER(S):

BUSINESS / TRADE REFERENCES:

TRADE REFERENCE #1 (COMPANY NAME):

REFERENCE #1 Addr.:

REFERENCE #1 PHONE:

REFERENCE #1 CONTACT NAME:

TRADE REFERENCE #2 (COMPANY NAME):

REFERENCE #2 Addr.:

REFERENCE #2 PHONE:

REFERENCE #2 CONTACT NAME:

TRADE REFERENCE #3 (COMPANY NAME):

REFERENCE #3 Addr.:

REFERENCE #3 PHONE:

REFERENCE #3 CONTACT NAME:

BUSINESS DESCRIPTION:

SIZE (AVE. SQ FT) AND NUMBER OF SALES OFFICES:

NUMBER OF SALES PERSONNEL (TOTAL):

NUMBER OF TECHNICAL SUPPORT PERSONNEL (TOTAL):

NUMBER OF FIELD SERVICE PERSONNEL (TOTAL):

NUMBER OF MARKETING SUPPORT PERSONNEL (TOTAL):

NUMBER OF INTERNET WEBSITE SUPPORT PERSONS (TOTAL):

WORLD WIDE WEBSITE(S) - please list all -:

PRINCIPAL SALES MEANS (MAIL ORDER,
NET, DIRECT, STORE, PLEASE LIST ALL):

PRINCIPAL SALES CONTRACTORS:

TYPICAL SINGLE SALE AMOUNT - BICYCLE (in US dollars):

TYPICAL SINGLE SALE AMOUNT - MOTORCYCLE (in US dollars):

TYPICAL SINGLE SALE AMOUNT - MOPED or SCOOTER (in US dollars):

TYPICAL SINGLE SALE AMOUNT - MOTOR VEHICLE (in US dollars):

TYPICAL SINGLE SALE AMOUNT - SIGNIFICANT SERVICE JOB (in US dollars):

MOST RECENT ANNUAL SALES (if available, please provide 2 years of
financial statements by mail, email or by fax: 908-272-6297):

MARKET DESCRIPTION (LIST ALL MARKETS YOU SELL TO AND WHAT YOU SELL):

REGIONS YOU SELL TO (INDICATE ANY THAT APPLY):

North Eastern USA
Mid-Atlantic USA
South East USA
North Western USA
South Western USA
Mid Western USA
Southern USA
Academic / Education
US Government (Non-Military)
US Military
Mexico/Canada
Latin America
Northern South America
Central South America
Southern South America
Caribbean
Eastern Europe
Western Europe
Scandinavia
Mediterranean
Middle East
North Africa
Central Africa
Southern Africa
India/Pakistan/Bangladesh
Western Asia
Central Asia
East Asia
China
Russian Federation
Hong Kong / Malaysia / Taiwan / Singapore
Australia / New Zealand
Japan / Philippines
New Foundland / Iceland / Greenland
International Military or Munitions
Aerospace Specific
International Government
General Sales (All Regions)

FORM SUBMISSION

PRESS: [ submit ] to send your application. By doing so, you are automatically agreeing to allow Computer Sales & Service to submit a request to your bank and credit agencies seeking further information. If you do not wish us to, press [ Clear Form ] instead. You may also press [Clear Form] to restart entry.

top of form >

If you press [ submit ], a copy of the form we receive will be displayed. You can print it or save it to disk, then return to the main website by hitting BACK twice... We will need you to FAX a copy of a company check with the word VOID in big bold letters in the Pay To and Dollar Amount fields. Our FAX number is: 908-272-6297 along with a copy of your SALES TAX PERMIT(s) for any state you're authorized to do business in.

TO CANCEL: CLICK HERE

Comments? Contact the HTML Development Group at support@compamericadirect.com

-- START HERE -- PLEASE ANSWER ALL QUESTIONS --

Contact Name:
(Required)

E-Mail Address:
(Required)

Company Name:

Phone Number:

Fax Number:

LEGAL Address:

MAILING Address:

SALES TAX ID. #:

Federal E.I.D. #:

Year & State organized:

TYPE OF ORGANIZATION
Corporation, Limited Liability Corp, Partnership or Proprietership

Owner's Name(s):

Owner's Address(s):

Owner's Phone(s):

Owner's Social Sec. #:

President's Name:

Pres's Social Sec. #:

Public Company? (y/n):

Firm ever declared bankruptcy? When? (Incl. Court, Docket, Status):

Firm purchase a bankrupt?
(or it's Assets, name it / address)

Has Firm had prior name(s)? (Include them)

Owner ever declared bankruptcy?
(Incl. Court, Docket, Status)

Has Firm a Parent Company?
(Incl. Name, Phone, TAX ID required)

Sell to Government Agencies?
(Supply Name, and Contract List)

Is your business
International? (y/n)
(ie: owned by foreign ownership)

TYPE OF APPLICATION:

TYPE OF REPLY REQUIRED:

BANK REFERENCES:

BANK REFERENCE #1 ( BANK NAME):

BANK #1 Addr.:

BANK #1 PHONE:

BANK #1 CONTACT NAME:

BANK #1 ACCOUNT NUMBER(S)/Type:

BANK REFERENCE #2 (BANK NAME):

BANK #2 Addr.:

BANK #2 PHONE:

BANK #2 CONTACT NAME:

BANK #1 ACCOUNT NUMBER(S):

BUSINESS / TRADE REFERENCES:

TRADE REFERENCE #1 (COMPANY NAME):

REFERENCE #1 Addr.:

REFERENCE #1 PHONE:

REFERENCE #1 CONTACT NAME:

TRADE REFERENCE #2 (COMPANY NAME):

REFERENCE #2 Addr.:

REFERENCE #2 PHONE:

REFERENCE #2 CONTACT NAME:

TRADE REFERENCE #3 (COMPANY NAME):

REFERENCE #3 Addr.:

REFERENCE #3 PHONE:

REFERENCE #3 CONTACT NAME:

-- START HERE -- PLEASE ANSWER ALL QUESTIONS --

Contact Name:(Required)

E-Mail Address: (Required)

Company Name:

Phone Number:

Fax Number:

LEGAL Address:

MAILING Address:

SALES TAX ID. #:

Federal E.I.D. #:

Year & State organized:

TYPE OF ORGANIZATION Corporation, Limited Liability Corp, Partnership or Proprietership

Owner's Name(s):

Owner's Address(s):

Owner's Phone(s):

Owner's Social Sec. #:

President's Name:

Pres's Social Sec. #:

Public Company? (y/n):

Firm ever declared bankruptcy? When? (Incl. Court, Docket, Status):

Firm purchase a bankrupt? (or it's Assets, name it / address)

Has Firm had prior name(s)? (Include them)

Owner ever declared bankruptcy? (Incl. Court, Docket, Status)

Has Firm a Parent Company? (Incl. Name, Phone, TAX ID required)

Sell to Government Agencies?(Supply Name, and Contract List)

Is your business International? (y/n) (ie: owned by foreign ownership)

TYPE OF APPLICATION:

TYPE OF REPLY REQUIRED:

BANK REFERENCES:

BANK REFERENCE #1 ( BANK NAME): BANK #1 Addr.: BANK #1 PHONE: BANK #1 CONTACT NAME: BANK #1 ACCOUNT NUMBER(S)/Type:

BANK REFERENCE #2 (BANK NAME): BANK #2 Addr.: BANK #2 PHONE: BANK #2 CONTACT NAME: BANK #1 ACCOUNT NUMBER(S):

BUSINESS / TRADE REFERENCES:

TRADE REFERENCE #1 (COMPANY NAME): REFERENCE #1 Addr.: REFERENCE #1 PHONE: REFERENCE #1 CONTACT NAME:

TRADE REFERENCE #2 (COMPANY NAME): REFERENCE #2 Addr.: REFERENCE #2 PHONE: REFERENCE #2 CONTACT NAME:

TRADE REFERENCE #3 (COMPANY NAME): REFERENCE #3 Addr.: REFERENCE #3 PHONE: REFERENCE #3 CONTACT NAME:

Contact Name:
(Required)

E-Mail Address:
(Required)

TYPE OF ORGANIZATION
Corporation, Limited Liability Corp, Partnership or Proprietership

Firm purchase a bankrupt?
(or it's Assets, name it / address)

Owner ever declared bankruptcy?
(Incl. Court, Docket, Status)

Has Firm a Parent Company?
(Incl. Name, Phone, TAX ID required)

Sell to Government Agencies?
(Supply Name, and Contract List)

Is your business
International? (y/n)
(ie: owned by foreign ownership)

BANK REFERENCE #1 ( BANK NAME):

BANK #1 Addr.:

BANK #1 PHONE:

BANK #1 CONTACT NAME:

BANK #1 ACCOUNT NUMBER(S)/Type:

BANK REFERENCE #2 (BANK NAME):

BANK #2 Addr.:

BANK #2 PHONE:

BANK #2 CONTACT NAME:

BANK #1 ACCOUNT NUMBER(S):

TRADE REFERENCE #1 (COMPANY NAME):

REFERENCE #1 Addr.:

REFERENCE #1 PHONE:

REFERENCE #1 CONTACT NAME:

TRADE REFERENCE #2 (COMPANY NAME):

REFERENCE #2 Addr.:

REFERENCE #2 PHONE:

REFERENCE #2 CONTACT NAME:

TRADE REFERENCE #3 (COMPANY NAME):

REFERENCE #3 Addr.:

REFERENCE #3 PHONE:

REFERENCE #3 CONTACT NAME: