DEALER APPLICATION MAIL: DL WHOLESALE, INC LAS POSITAS RD, UNIT A LIVERMORE, CA 94551

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1 DEALER APPLICATION DEAR PROSPECTIVE DEALER, THANK YOU FOR YOUR INTEREST IN DOING BUSINESS WITH US AT DL WHOLESALE INC. INCLUDED IN THIS PACKET IS THE DEALER APPLICATION AND AN ORDER FORM. PLEASE FILL OUT ALL PAGES OF THE APPLICATION AND ATTACH A COPY OF YOUR BUSINESS LICENSE. PLEASE MAKE SURE TO FILL OUT THE APPLICATION IN ITS ENTIRETY AND RETURN IT TO US EITHER BY , FAX, OR MAIL. DONALD@DLWHOLESALE.COM FAX #: MAIL: DL WHOLESALE, INC LAS POSITAS RD, UNIT A LIVERMORE, CA THANK YOU AGAIN FOR YOUR INTEREST, AND WE LOOK FORWARD TO DOING BUSINESS WITH YOU!

2 STEP 1: COMPANY PROFILE LEGAL COMPANY NAME: PHYSICAL STORE ADDRESS: SUITE, UNIT #: BUSINESS PHONE #: WEBSITE: MAILING ADDRESS: (if different than above) STEP 2: BUSINESS INFORMATION BUSINESS LICENSE NUMBER: TAX ID/SOCIAL SECURITY #: NUMBER OF YEARS IN BUSINESS: ESTIMATED MONTHLY PURCHASES: DEALER APPLICATION STEP 3: COMPANY OWNERSHIP (CONTINUED) OWNER/OFFICER NAME: TITLE: HOME ADDRESS: HOME/MOBILE #: OWNER/OFFICER NAME: TITLE: HOME ADDRESS: HOME/MOBILE #: STEP 4: BANK REFERENCES BANK NAME: BRANCH: MAILING ADDRESS: ACCOUNT #: STEP 3: COMPANY OWNERSHIP SOLE PROPRIETORSHIP PARTNERSHIP INCORPORATED TYPE OF BUSINESS: STATE IN WHICH INCORPORATED: YOUR APPLICATION IS NOT COMPLETE UNTIL A COPY OF YOUR BUSINESS LICENSE HAS BEEN SUBMITTED WITH THIS APPLICATION BANK NAME: BRANCH: MAILING ADDRESS: ACCOUNT #: STEP 5: FORM OF PAYMENT COD CREDIT CARD RESALE (RESALE CERTIFICATION CARD REQUIRED) SELLER S PERMIT #: SIGNATURE PRINT DATE

3 CONTACT INFORMATION DAYS & HOURS OF OPERATION SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY OWNERS AND/OR OFFICERS DELIVERY INFO COMMERCIAL LOADING DOCK AVAILABLE? YES NO FORK LIFT AVAILABLE? YES NO STORE MANAGER BUYERS/PURCHASING/ORDERING DEPT. ACCOUNTING/PAYABLES CONTACT YOUR APPLICATION IS NOT COMPLETE UNTIL A COPY OF YOUR BUSINESS LICENSE HAS BEEN SUBMITTED WITH THIS APPLICATION

4 CREDIT CARD AUTHORIZATION FILL OUT ONLY IF YOU SELECTED CREDIT CARD AS YOUR METHOD OF PAYMENT BUSINESS CARDHOLDER CARD TYPE: VISA MASTERCARD AMERICAN EXPRESS CARD NUMBER: EXPIRATION DATE: CVV #: (3 OR 4 DIGIT SECURITY #) BILLING ADDRESS: COUNTRY: I AUTHORIZE DL WHOLESALE, INC. TO CHARGE MY CREDIT CARD IN THE AMOUNT OF: $ (OPEN) USD (U.S. DOLLARS) PRINTED SIGNATURE: DATE:

5 DL WHOLESALE, INC LAS POSITAS RD, UNIT A LIVERMORE, CALIFORNIA 94551, U.S.A. PHONE: FAX: UPON COMPLETION OF THIS ORDER FORM, PLEASE FAX IT TO OR IT TO ORDERS@DLWHOLESALE.COM AND WE WILL CONTACT YOU TO PROCESS THE ORDER ORDER FORM BILL TO: NAME: COMPANY: STREET ADDRESS: CITY, STATE, ZIP: PHONE #: SHIP TO: NAME: COMPANY: STREET ADDRESS: CITY, STATE, ZIP: PHONE #: ITEM # QUANTITY DESCRIPTION UNIT PRICE TOTAL I HEREBY CERTIFY THAT ALL PRODUCTS AND QUANTITIES ARE CORRECT, AND I UNDERSTAND DL WHOLESALE, INC. IS NOT RESPONSIBLE FOR ANY ERRORS ON THIS FORM SIGNATURE: DATE:

6 BUSINESS LICENSE YOUR APPLICATION IS NOT COMPLETE UNTIL A COPY OF YOUR BUSINESS LICENSE, AND SELLER'S PERMIT HAS BEEN SUBMITTED WITH THIS APPLICATION.

7 STORE PICTURES YOUR APPLICATION IS NOT COMPLETE UNTIL PICTURES OF YOUR RETAIL STORE HAS BEEN SUBMITTED WITH THIS APPLICATION. PICTURES CAN BE ED TO: PICTURES CAN BE MAILED TO: DL Wholesale Attn: Tony 7041 Las Positas rd. Unit A Livermore, CA 94551

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