Electronics, Inc.

710 North Mariposa Street

Burbank, CA 91506

Tel. (818) 239 -1500

Fax (818) 239 -1506

DEALER CREDIT APPLICATION

Please complete this entire form for consideration as DWIN Electronics' Dealer. Upon completion, please mail to the address listed.

_______________________________________________________________________________________
Company Name

D/B/A

Federal Tax ID #

_______________________________________________________________________________________
Address

Suite or Building

_______________________________________________________________________________________
City

State

Zip

Country

_______________________________________________________________________________________
Phone

Fax

E-Mail address

_______________________________________________________________________________________
Shipping Address if different than above

Suite or Building

_______________________________________________________________________________________
City

State

Zip

Phone

Bank Reference
_______________________________________________________________________________________
Bank
Account Number
___________________________________________________________________________________________________________________
Address
Phone / Fax
___________________________________________________________________________________________________________________
City
State
Zip
Person to contact

Trade References

(Please list three consumer electronic vendors, include film-screen, projector and line multiplier manufacturers.)
1._________________________________________________________________________________________________________________
Company
Account Number
___________________________________________________________________________________________________________________
Address
Phone / Fax
___________________________________________________________________________________________________________________
City
State
Zip
Person to contact
2._________________________________________________________________________________________________________________
Company
Account Number
___________________________________________________________________________________________________________________
Address
Phone / Fax
___________________________________________________________________________________________________________________
City
State
Zip
Person to contact
3._________________________________________________________________________________________________________________
Company
Account Number
___________________________________________________________________________________________________________________
Address
Phone / Fax
___________________________________________________________________________________________________________________
City
State
Zip
Person to contact

Person to Contact About Account:___________________________________________________________________________

Name

Title

The undersigned will/will not submit a financial statement. Any misrepresentation in this application will be considered
evidence of a fraud, since this information is the basis for the granting of credit.
As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct.
YOU ARE HEREBY AUTHORIZED TO CONTACT THE ABOVE REFERENCES.

_______________________________/_______________________________/________________________
AUTORIZED BY (SIGNATURE)

PRINT NAME & TITLE

Page 1 of 4

CONTACT INFORMATION

DATE

The following information is for DWIN internal use only. DWIN does not sell or distribute its mailing lists and regard this information
as CONFIDENTIAL.
_______________________________________________________
President / Owner

____________________________________________________
Sales Manager / Director

_______________________________________________________
Purchaser

____________________________________________________
Technical Service Manager

_______________________________________________________
Accounts Payable

____________________________________________________
Number of Employees

_______________________________________________________
Corporate Annual Sales / Projection Video Sales Volume

____________________________________________________
Year Established
/ *CA resale #
(Required if selling in CA only)

Ownership:
Principal:

Sole Owner

Title

SS#

Home Address

___________________________________________________________________________________________
Name

Principal:

Corporation

___________________________________________________________________________________________
Name

Principal:

Partnership

Title

SS#

Home Address

___________________________________________________________________________________________
Name

Title

SS#

Has the firm or any of its Principals ever been bankrupt?

Home Address

Yes

No

If yes, explain:
___________________________________________________________________________________________________
___________________________________________________________________________________________________________
PERSONAL GUARANTEE
In consideration of credit being extended by Dwin Electronics, Inc. to the above named applicant for merchandise to be
purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity,
the undersigned guarantor or guarantors each hereby contract and guarantee to Dwin Electronics, Inc. the faithful payment,
when due, of all accounts of said applicant for the purchases made within one year after the date of this application. The
undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by Dwin
Electronics, Inc., extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other
notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this
guarantee. Absent written permission by creditor, this personal guarantee may not be revoked.

_______________________________/_______________________________/________________________
SIGNATURE

PRINT NAME & TITLE

DATE

_______________________________/_______________________________/________________________
SIGNATURE

PRINT NAME & TITLE

DATE

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MARKETING INFORMATION
Primary Customers:
Consumers___________%

Industrial_____________%

Other______________%

Do you sell via mail order and/or Internet?

Yes_______

No________

_______________________________________
Number of Outlets

Geographic Market

Please describe the geographic area where you do business.

___________________________________________________________________________________________________________________

_______________________________________________________________________________________
Sales Information
Please list all brands/ lines you carry and purchase direct from the manufacturer:

Manufacturer

Brand

Model

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

__________________________________________________________________________
_________________________________________________________________________________________
Which of DWIN Electronics' product lines are you interested in?
CRT Projectors

DLP Projectors

Line Multipliers

All

Where did you hear about DWIN Electronics, Inc.?

Referral___________________________________

Magazine____________________________________

Trade show________________________________

Other_______________________________________

Page 3 of 4

Questions
Please answer all the following questions regarding types of regularly installed systems. Please be aware that as a DWIN Electronic 's
Dealer we will at some point visit your facilities and ask to see the installations which you feel represent your best efforts.
1.

Do you, or any of your outlets act as retail stores open to the public?

Yes

No

2.

Do you have a showroom with functioning systems for demonstrations?

Yes

No

3.

Do you allow customers to walk in without a prior appointment?

Yes

No

4.

Can a "walk in" customers buy a product from your showroom?

Yes

No

5.

Do your own employees exclusively do audio/video systems designs & installs?

6.

If "Yes" on 5: How many people do you employ for systems design & installs?

Yes

No

_______________________________________________
7.

Do you do any commercial audio/video contracting?

Yes

8.

What percentage of your business is in residential audio/video contracting?

No

__________________________________________________
9.

How many years have you been doing business in residential audio/video contracting?
_________________________________________

10. What was your total amount for residential audio/video contracting sales volume last year?
_____________________________________
11. What is your total estimated amount for residential audio/video contracting sales volume this year?
_____________________________
12. What is your total target amount of DWIN Electronics product purchases?__________________________________________________
13. What is the estimated average value of residential audio/video systems you have completed to date?
_____________________________
14. What is the value of premium, high-end systems which you have installed?
__________________________________________________
15. How many premium, high-end systems do you do a year, approximately?
____________________________________________________
16. How many systems do you design/install annually in total?________________________________________________________________

INCOMPLETE APPLICATIONS WILL BE

RETURNED
DO NOT WRITE BELOW THIS LINE
_______________________________________________________________________________________
Credit Application received______________________________
___________________________________________
Initials
Date
Account Number
Bank Reference received________________________________
______________
___________________
Initials
Date
Status
Terms
Credit Reference received_______________________________
Initials
Date
Credit Reference received_______________________________
Initials
Date
Credit Reference received_______________________________
___________________________________________
Initials
Date
Approved By:
Remarks:______________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

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