Powerside New Customer Setup Form

Test - Powerside New Customer Setup Form
Please complete the following so that we may proceed with opening your account and to ensure smooth delivery of your orders. To update your information, please send your request to orders@powerside.com. Unless otherwise indicated on the Purchase Order and confirmed by Powerside, the following information will be applied for all shipments.
Company Name*
Website
Date

MonthDayYear
Date
Email*
example@example.com
End User

None
Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip CodeCountry
Accounting Contact

First NameLast Name
Title
Accounting Email
example@example.com
Accounting Phone Number
Please enter a valid phone number.
Shipping Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip CodeCountry
Shipping Contact

First NameLast Name
Title
Shipping Email
example@example.com
Shipping Phone
Please enter a valid phone number.
Fax
Please enter a valid phone number.
Freight Terms
Shipping Method
Shipping Account #
Incoterms
International: In general, all shipments are Ex-Works Powerside, unless otherwise agreed
US Only: In general, all shipments are FOB Origin (Powerside)
Incoterms
Resale Certificate:

YesNo
Tax Exempt:

YesNo
File Upload

Cancelof
Powerside's company policy is that we only accept Electronic Funds (wire, ACH, EFT). If you wish to pay via check, please reach out to ar@powerside.com as soon as possible. We also accept credit card payments, but all transactions over $5,000.00 are subject to a 3% adminstration fee.
By signing below, I hereby represent that I am authorized to submit and approve the above information on behalf of the company named above and that the information is true and complete.
Signature

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Tax Exemption
The US Government requires vendors to demonstrate that their clients are legitimately tax-exempt for transactions regarding the acquisition or resale of equipment goods and services. For this reason, we need to keep on record evidence that this sale is tax exempt. We therefore need you to confirm which of the below situations apply to your company (check the appropriate item), and if required, to provide the supporting evidence.
Are you US Tax Exempt*

US Tax Exempt
The products purchased by your company will be resold.Please affirm if these purchases were made for resale by signing on the lineprovided below. In addition, please attach your resale certificate(s) for thestate to which our product was delivered. The products purchased were purchasedwith the intent that these products would be resold._________________________________________Authorized Company RepresentativeYour company is a tax exempt organization and not subject to sales and use tax inthe state to which our products were delivered. Please attach your sales and usetax exemption certificate.Your company has a direct pay agreement with the state to which our productswill be delivered. (Please attach a copy of your direct pay permit.)Your company is not tax exempt, yet will self-assess and remit the use tax on itspurchases as noted on the attached Sales and Use Tax-Self-Assessment Affidavit.Please complete the Sales and Use Tax- Self-Assessment Affidavit attached.Your company is not tax exempt.
SALES AND USE TAX - SELF-ASSESSMENT AFFIDAVIT

The undersigned purchaser hereby certifies that:
We will self-assess sales and use tax on all the invoices received from for the period
beginning Date through Date.
Purchasers Name   First Name   Last Name
Purchasers Address     Street Address   Address Line 2   City   State   Zip

Signature
    Sales tax registration #
SALES AND USE TAX - STATE SALES TAX AUDIT AFFIDAVIT

The undersigned purchaser hereby certifies that:
We will be audited by the state and will remit the applicable sales taxes on all the
invoices received from Date for the period beginning
through Date.
Purchasers Name   First Name   Last Name
Purchasers Address     Street Address   Address Line 2   City   State   Zip

Signature
    Sales tax registration #

Should be Empty:

Test - Powerside New Customer Setup Form

Incoterms

Tax Exemption