Application Step 1 of 5 20% General Information:Application Type* I am a new customer and would like to set up an account with Net 30 day terms (three credit references are required). I wish to establish a Credit Card account (credit references not required but this application & Terms & Conditions must be signed & returned). I am an existing account and would like to increase my current credit limit, upgrade or apply for a line of credit (three credit references are required). Company Name* DBA Company Category Chimney Specialist Brick & Mortar Hearth Retail Store Brick & Mortar Other Retail Store Installer ECommerce Consumer Sales Hardscaping/Landscaping Appliance Installation Contact Name* First Last Contact Phone Number*Contact Email* Mailing/Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Company Website Shipping Address* Same as previous Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Brands Interested In* BARBARA JEAN COLLECTION BEAR MOUNTAIN BBQ CONDAR CO-MATE CHIMNEY SAVER DRAW COLLAR DIMPLEX CAFRAMO AJ MANUFACTURING FABRICATION SPECIALTIES FLAME-TEC GOLDEN BLOUNT GRILLGRATE GREEN MOUNTAIN GRILLS GOODS OF THE WOODS HY-C FIRE CHIEF ICC IMPERIAL MANUFACTURING KOZY HEAT LITTLE BUCKET LYNN MANUFACTURING MHP MASON-LITE MINUTEMAN NEW ENGLAND CHIMNEY SUPPLY OUTDOOR PLUS OL' HICK COOKING PELLETS PACIFIC ENERGY PILGRIM HOME & HEARTH PROMAT POWERSMITH PIAZZETTA RSF FIREPLACES RENAISSANCE FIREPLACES RUTLAND FORREST PAINT DURAVENT SKYTECH SMOKIES SPEEDY WHITE TOWN & COUNTRY ORTAL VISTAFLAME SUMMERSET AMERICAN MADE GRILLS GRAND CANYON HART & COOLEY KIDCO TRUEFLAME LOUISIANA GRILLS FABER NECTRE PLEASANT HEARTH Purchasing Information:Accounts Payable Contact* First Last Accounts Payable Email* Phone*I would like to receive my invoices & statements via (EMAIL OR MAIL):* Purchasing Email* Tax ID* Name of Principal Owner:* First Last Website Login Credentials(ndlhearth.com)Username* Password will be provided once account is approved by NDL. Credit References *NOT REQUIRED*Credit Reference #1Company Name* Contact Person* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email or Fax* Credit Reference #2Company Name* Contact Person* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email or Fax* Credit Reference #3Company Name* Contact Person* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email or Fax* SIGNING THIS FORM IS A REQUEST TO ESTABLISH AN ACCOUNT WITH NORTHEAST DISTRIBUTION LTD. I UNDERSTAND THAT CREDIT PRIVILEGES, IF GRANTED, MAY BE WITHDRAWN AT ANY TIME. I UNDERSTAND THAT WE WILL BE RESPONSIBLE FOR AND PAY ANY AND ALL COSTS OF COLLECTING OVERDUE AMOUNTS INCLUDING COLLECTION COSTS, COURT COSTS AND LEGAL FEES. I FURTHER UNDERSTAND THAT ALL INFORMATION IS CONFIDENTIAL AND WILL ONLY BE USED BY NORTHEAST DISTRIBUTION LTD FOR THE PURPOSE OF CUSTOMER CREDIT CHECKS. I AUTHORIZE INQUIRY INTO TRADE REFERENCES/CREDIT INFORMATION PROVIDED ABOVE.Terms & Conditions* I agree.*Credit Limit Requested* Principal Owner (Signature)* Date* MM slash DD slash YYYY Office Hours: Monday through Friday 8:30 am to 5:00 pm. Closed Saturday, Sunday & major holidays. Terms: ALL ORDERS 2% 10 DAYS/NET 30 DAYS ON ACCOUNTS APPROVED FOR CREDIT TERMS. SPECIAL PROGRAMS WILL HAVE SPECIFIED DUE DATES. DISCOUNT IS NOT OFFERED WITH CREDIT CARD PAYMENTS. CHECKS OR ACH PAYMENTS MUST BE RECEIVED AT NORTHEAST WITHIN 10 DAYS OF INVOICE DATE TO TAKE ADVANTAGE OF 2% DISCOUNT. NORTHEAST DOES NOT ACCEPT CREDIT CARDS ON EARLY BUY PAYMENTS. LOCK-IN DISCOUNTS ARE FORFEITED IF EARLY BUY ORDER PAYMENT IS DELINQUENT. Freight: All orders will be FOB Exeter, NH- unless specified in a specific program or promotion. All orders will be shipped at NDL’s discretion and NDL reserves the right to choose carrier. Standard pallet rates: $60/skid (New England); $90/skid (NY/NJ/PA/MD/DE/DC). Prepaid Freight Program: Any SINGLE SHIPMENT totaling $1,800 net (New England)/ $2,100 net (NY/NJ/PA/MD/DE/DC) or more will qualify for prepaid freight. Backorders are excluded from Prepaid Freight Program and Dealer is responsible for freight charges on backorder shipments. Only standard pallet rates qualify. Any additional shipping fee or surcharges (see below) will be the responsibility of the receiver. Additional shipping charges are the responsibility of the receiver, and include: “Assisted” pallet unloading, call-ahead fees, re-delivery fee, lift gate requirements and/or residential or island deliveries (ie, Cape Cod, Metro NY, and Long Island may be subject to additional charges). Direct shipments from the factory to Dealer will be subject to manufacturer surcharges and freight charges (less skid rate if order qualifies for prepaid freight). Damages: All FOB Exeter, NH shipments are the responsibility of the receiver. All shipments must be inspected for damages and shortages and recorded on the BILL OF LADING before you sign for the shipment. You must then notify Northeast immediately (within 48 hours) of any damages or shortages. We cannot be held responsible if the above procedure is not followed. Past Due Accounts: All past due accounts will be charged 1.5% per month and will be on CREDIT HOLD until the account is returned to current status. All returned checks & ACH’s will be charged a $55.00 processing fee. THE UNDERSIGNED AGREES TO PAY ALL FINANCE CHARGES, COLLECTION COSTS, COURT COSTS AND LEGAL FEES INCURRED TO COLLECT DELINQUENT BALANCES. Prices: EVERY EFFORT HAS BEEN MADE TO ENSURE THE ACCURACY OF OUR WEBSITE AND ALL OTHER PRICING SET FORTH BY NORTHEAST. NORTHEAST DISTRIBUTION LTD RESERVES THE RIGHT TO CORRECT ANY AND ALL ERRORS ON OUR WEBSITE WITHOUT NOTICE. If you are unsure of your discount, please call us at 800-801-6472. ALL PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE. Returned Goods: NORTHEAST WILL NOT ACCEPT ANY RETURNED or REFUSED GOODS WITHOUT PRIOR AUTHORIZATION AND A RETURN AUTHORIZATION NUMBER (RA #). All returned goods must be returned by one of Northeast’s major carriers. All returned goods are subject to a 20% restocking and handling charge and any applicable freight charges. All goods must be returned in the original packaging. Special or custom orders are not returnable. Please call to make arrangements for returning goods. ALL RETURNS MUST BE COMPLETE WITHIN 30 DAYS FROM ORIGINAL INVOICE DATE. Warranty: All credit for warranty work or parts will be issued when Northeast has received the fully completed warranty form. If parts need to be returned, credit will be issued when the parts are received at Northeast. Please make sure all warranty work and parts are claimed on the proper warranty credit form from Northeast. Please apply for warranty after the job is complete. Northeast will not be responsible for your tardiness. The best policy is to send all warranty claims immediately, as some Manufacturers have time limits on warranty claims. All invoices associated with warranty are due within net 30 days and are subject to finance charges. Display & CO-OP Advertising Programs: Northeast honors most manufacturer display and co-op advertising programs. Please contact Northeast for complete details or additional forms. Northeast processes most credits immediately, but some credits could take up to 90 days to process. Credits are approved and issued by the manufacturer through NDL. Credits are not to be taken before being issued to your account. Your account must be current in order to participate/receive credit.Terms & Conditions* I agree to the Terms & Conditions*BY PRINTING NAME BELOW, YOU ACKNOWLEDGE RECEIPT, UNDERSTAND AND ACCEPT THE TERMS AND CONDITIONS SET FORTH BY NORTHEAST DISTRIBUTION LTD.Principal Owner (Signature)* Date* MM slash DD slash YYYY
