Pearl Mantels Pre-Pay Application

PREPAY APPLICATION
Pearl Mantels • PO Box 1688, Collierville, TN 38027-1688 • Phone (901) 853-8237 • Fax (901) 861-1057
Fields marked in RED are required. Please view our Privacy Statement concerning collected information.

Business Name

Mailing Address /Street:

City

State

Zip Code

Required format: 10001 or 10001-1111

Business Phone

Required format: 222-333-4444

Physical addess: Same as above

(If different list below)

Physical Address / Street

City

State

Zip Code

Required format: 10001 or 10001-1111

Email Address

Website

Pearl Sales Rep.

Type of Business: 1) Corporation 2) Individual 3) Other (please describe)

Number of Years in Business:

NOTE: For all states where sales tax is collected, we require a copy of your state sales tax certificate AS WELL AS a completely filled out and signed copy of your sales tax exemption certificate to be submitted with this application. If you are not sure where to acquire your exemption certificate, please click HERE and locate the appropriate state.

Select your state to see if tax forms are required:

** SALES TAX DOCUMENTS ARE NOT REQUIRED **

** SALES TAX DOCUMENTS ARE REQUIRED **
State Sales & Use Tax Certificate #

Click the Choose File button to attach your State Sales and Use Tax Certificate:

Click the Choose File button to attach your Sales Tax Exemption Certificate:

We are a participant in PAPERLESS OFFICE.

Please provide an email address for us to send to the following (WE WILL NOT MAIL THESE):

Invoices eMail

Credit Memos eMail

Statements eMail

Sales Order Confirmations eMail

Select Your Preferred Prepayment Method: 1) Send Check in Mail 2) PayPal (4% fee) 3) ACH Bank Transfer

Contacts for your Business. All fields are Required.

Owner Name

Phone

Required format: 222-333-4444

Fax

Required format: 222-333-4444

Manager Name

Phone

Required format: 222-333-4444

Fax

Required format: 222-333-4444

Accounts Payable Name

Phone

Required format: 222-333-4444

Fax

Required format: 222-333-4444

Buyer Name

Phone

Required format: 222-333-4444

Fax

Required format: 222-333-4444

Inventory Updates Name

Phone

Required format: 222-333-4444

Fax

Required format: 222-333-4444

Pricing Updates Name

Phone

Required format: 222-333-4444

Fax

Required format: 222-333-4444

In order to serve you better, we would like to learn more about your business. Please answer the following questions.

How did you hear about our product?

Have you ever purchased our product?

Which best describes your business? (please check all that apply):

1) Retail Hearth Products 2) Retail Building Supply 3) Internet Retailer 4) Two-Step Distributor

5) Other (please describe):

If Internet Retailer, will you be selling as a 3P on online marketplaces? Yes No

If Yes, please list which ones you will be selling on:

Is the physical address you provided earlier how you would like your company referenced on our website? Yes No

If No, please let us know the correct address, phone, and website:

Do you have more than 1 location? Yes No

If Yes, please provide the addresses and phone numbers for each of your locations:

Would you like all of your locations to be shown on our website? Yes No

Additional Comments:

To the best of my knowledge, all information entered on this form is correct and true:

Name

Title

Date

Required format: mm/dd/yyyy

NOTE:YOU MUST VERIFY I'M NOT A ROBOT (Above).

This form will retain your input data until you click the SUBMIT or RESET button.