To Which Sales Division Should We Direct Your Application?
Please Select One:
[Select One]
SYNNEX Broadline Distribution
New Age Electronics
PLEASE
CHECK ONE:
Credit Card Terms COD-Company Check Net Terms
If Credit Card terms are selected then SYNNEX requires a copy of your Drivers License and a Credit Card Authorization Form to be faxed to secured fax number 510-668-3144.
Requested Credit
Limit:
Order Pending:
Yes No
Order Pending Amount:
Business is a:
Corporation - Private
Corporation - Public
Partnership
Proprietorship
Corporation: Although not a requirement to complete the
credit application process, a personal guarantee from you on file
would be most helpful for SYNNEX Corporation. Click on
the personal guarantee link to download a form
now.
SYNNEX
Account Number (if any):
EMJ
Account Number (if any):
Synnex Sales Rep. Name:
Synnex Sales Rep. Code:
Form Submitted By:
Title:
Telephone Number:
Ext:
Fax Number:
Email Address:
Exact Legal Company or Corporate Name:
Does Your Company have a Website?
Yes
No
Website Address:
Doing
Business As:
Billing Address:
City:
State/Province:
Zip Code/Postal Code:
Country:
Is the Shipping Address the Same?
Yes
No
Shipping
Address:
City:
State/Province:
Zip
Code/Postal Code:
Country:
Former Company Names:
Aliases:
Year
Started:
# of Employees.:
D &
B #:
State of Inc.:
Federal Id#:
Trading Symbol?
Name of Exchange Stock Traded:
Full Name (Owner/Principle):
Title:
Home Address:
City:
State/Province:
Country:
Zip Code/Postal Code:
Home Telephone:
Email:
SSN/SIN:
Date of Birth(mm/dd/yyyy):
Are you a:
Subsidiary Division
Parent
Company Name:
Address:
City:
State/Province:
Zip
Code/Postal Code:
Country:
Telephone Phone Number:
Website Address:
Top 3
Computer Lines:
Do you have an Affiliated or Related Company:
Affiliated / Related Company Name:
Address:
City:
State/Province:
Zip
Code/Postal Code:
Country:
Telephone Phone Number:
Website Address:
SYNNEX Corporation requests financial statements for the last two years (Balance Sheet, Income Statement, and Statement of Cash Flows) to be submitted
in consideration of any request for net terms. Current Financial Statements should be provided to SYNNEX at least every six months in order to maintain
an existing credit line and to consider any increase requests. This information will be for the exclusive use of the SYNNEX Credit Department and will
remain confidential. * The maximum credit line provided without financial statements is $25,000.
Financial Year End:
Do you have audited financials:
Will you release statements to us:
With a non-disclosure agreement:
Click on the non-disclosure agreement link to download a form now. This signed form will need to be faxed to Synnex at 510-668-3144.
Bank References
Bank Name:
Address:
City:
State/Province:
Zip Code/Postal Code:
Country:
Type of Account:
Checking
Saving
Bank Account Number:
Loan Number:
Date Opened(mm/dd/yyyy):
Contact Name:
Contact Phone Number:
Contact Fax Number:
Contact Email Address:
Credit
References (Major Suppliers)
Name
(1):
AR Contact
Name (1):
AR Contact
Email (1):
AR Contact
Phone Number(1):
AR Contact
Fax Number (1):
Contact
Address (1):
Contact
City (1):
Contact
State/Province (1):
Contact
Country (1):
Contact
Zip Code/Postal Code (1):
Account
Number (1):
Name
(2):
AR Contact
Name (2):
AR Contact
Email (2):
AR Contact
Phone Number(2):
AR Contact
Fax Number(2):
Contact
Address (2):
Contact City (2):
Contact
State/Province (2):
Contact Country (2):
Contact Zip Code/Postal Code (2):
Account
Number (2):
Name
(3):
AR Contact
Name (3):
AR Contact
Email (3):
AR Contact
Phone Number (3):
AR Contact
Fax Number(3):
Contact
Address (3):
Contact
City (3):
Contact
State/Province (3):
Contact Country (3):
Contact
Zip Code/Postal Code (3):
Account
Number (3):
Company Contacts
Owner/Manager:
Phone:
Ext:
Email:
VP/Director of
Sales:
Phone:
Ext:
Email:
Purchasing
Contact:
Phone:
Ext:
Email:
A/P Contact:
Phone:
Ext:
Email:
Total
Company Revenue:
Total
Hardware Revenue:
Total
Software Revenue:
Total
Service Revenue:
Years in
Business:
# of
Locations:
# of
Sales Employees:
# of
Tech Support:
Total
Systems Sold per Month:
Percentage of
Branded Systems Sold:
Do you sell Whitebox Systems:
Percentage of
Whitebox Systems Sold:
Primary
Customer Focus: (please
choose one)
Type of
Business:
DMR
E-commerce
Corporate Reseller
Retail
Value Added Reseller
Sub-Distributor
OEM
Consultants
Anticipated
monthly volume with SYNNEX:
Do you
have flooring accounts?
Have you
used alternate financing (i.e. leasing, joint purchase orders,
etc.?
Additional
Comments:
To complete your application, please remember to print it, sign it,
and fax it along with your sales tax exemption documents and any other documents
as required from the application to SYNNEX Account Setup at (510)668-3144.
If you are requesting credit card terms, please include a copy of the cardholder's
driver's license.
By accepting below you represent that your business
is a valid business entity and that you are an authorized
representative of the business with authority to enter into
contractual agreements. You hereby agree to the terms of sale listed
on each SYNNEX invoice. Invoices and account statements will be
provided by e-mail to the designated contact. In case of a credit
sale, you acknowledge that SYNNEX will charge a finance fee of one
and one-half percent per each thirty day period, or part thereof,
for any invoice that is past due. In order to induce SYNNEX to
extend credit for the purchase of SYNNEX's products ("Products") and
for other good and valuable consideration, you hereby convey, grant
and transfer to SYNNEX a purchase money security interest in the
Products and all proceeds until you perform all your obligations due
to SYNNEX. You agree to execute any financing statements that SYNNEX
may request in order to protect SYNNEX's security interest and
hereby authorize SYNNEX to execute and irrevocably appoint SYNNEX as
your attorney in fact for the execution of such financing statements
and for the exercise of its remedies as a secured party. On behalf
of your business, you certify that all information provided in this
Application is complete and accurate, and you authorize SYNNEX to
obtain information about you personally and your business from
credit reporting agencies and other sources SYNNEX deems appropriate
in considering this Application and subsequently for purposes of
updates, renewals, or extensions of credit granted as a result of
this Application or in receiving or collecting the Account. You
agree that your transactions with SYNNEX shall be governed by and
construed in accordance with the laws of the State of California,
without giving effect to its conflicts of laws principals. You
further agree that any lawsuit between SYNNEX and yourselves shall
be brought only in the state or federal courts of Alameda, Santa
Clara or San Francisco counties of California. You hereby submit to
the jurisdiction of such courts in any dispute with SYNNEX and you
waive any objections to venue being in such courts.
SYNNEX is pleased to welcome American Express® Cards. To apply for an American Express Card, go to amextnetwork.com or call
American Express at 1-800-THE-CARD.