Application for Reseller Program
Please complete and fax to 866-405-6751 / Accelerant Group
299 South Main St.#1300
Salt Lake City, UT84111
801.938.7111 Phone
866.405.6751 Fax
PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION:
Firm Name:Telephone : Fax:
Parent Corporation or AKA (Also Known As):
Address:
Purchasing Contact:
Email:
Billing Address:
City State Zip
Country
Type of Enterprise: Corporation Partnership
Proprietorship
Names of Principals and Titles:
Accounts Payable Contact:
Telephone ( )
Date Business Started Sales Terms Facilities
Owned or Leased?
Principal Lines Carried:
TRADE REFERENCES
1. Name / Type of Business
Contact Person / Phone Number
Address / City
State Zip
2. Name / Type of Business
Contact Person / Phone Number
Address / City
State Zip
Reseller Program
Terms and Conditions:
Reseller agrees to hold confidential any information provided by Accelerant Group and designated as reseller confidential. And to pay damages for any such information disclosed to other parties.
Accelerant Group’s acceptance of reseller s application to the Accelerant Group Reseller Program is contingent upon Accelerant Group’s review of same and subject to revocation at any time for any reason.
Reseller aggress not to represent itself as having a direct relationship with Accelerant Group, unless otherwise agreed to in writing by Accelerant Group.
Reseller agrees to offer Accelerant Group’s products only in accordance with such terms and conditions that are from time to time articulated by Accelerant Group on the website, by e-mail, or any other generally accepted means of communication.
Reseller understands that there is no expressed or implied exclusivity attached to Accelerant Group Reseller program.
Approved Accelerant Group Resellers may purchase directly from Accelerant Group, subject to account creation by Accelerant Group, and Reseller understands that the laws of the State of Utah govern the terms and conditions of the Accelerant Group Reseller program.
Accelerant Group reserves the right to modify or discontinue pricing, programs, offers, terms and conditions of the Accelerant Group Reseller program at any time and without any notice.
Accelerant Group makes no warranties about the accuracy of any information appearing on its website or any other media.
Agreement- By submitting t his application, you authorize Accelerant Group to make inquiries into the business/ trade references that you have supplied.
- I hereby agree to abide by the included Terms and Conditions, and acknowledge having read and understand the same.
Authorized Signatory ______Title ______
Date ______
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