Open Account - CTB WIRELESS

Thank you for your interest in establishing an account with CTB Wireless.

Credit Card Authorization Form

Please type in the fillable fields, print, sign and then fax back.

Shipping Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Company*
Website
Phone*
Fax
Email*
Billing Zipcode*
Is this a residential location?*
Year that the business was established*
# of Locations*
Purchasing Agent*
Email*
Office Phone*
Cell Phone
Resale License #
Federal Tax ID #
Alt. Contact
Title
Name
Office Phone
Cell Phone
Email
Payment Information
Cardholder's Name*
Cardholder's Title
Credit Card Number*
CVV Code
Type of Card*
Expiration Month*
Expiration Year*
Cardholder Signature*
Print Name
Date
MM slash DD slash YYYY
By my signature above, I hereby agree: I have the authority to use the credit card listed above for payment of goods purchased from CTB Wireless, Inc. I hereby authorize CTB Wireless, Inc. to charge against the indicated credit card any amounts due to CTB Wireless Inc.
By clicking submit I hereby agree: I have the authority to use the credit card listed above for payment of goods purchased from CTB Wireless, Inc. I hereby authorize CTB Wireless, Inc. to charge against the indicated credit card any amounts due to CTB Wireless, Inc. To be bound by CTB Wireless, Inc.'s Terms and Conditions, which I acknowledge is available for my review on www.ctbwireless.com.

California Resale Certificate

BOE-230 (7-02) GENERAL RESALE CERTIFICATE STATE OF CALIFORNIA BOARD OF EQUALIZATION

1. I hold valid seller’s permit number:*
2. I am engaged in the business of selling the following type of tangible personal property:*
3. This certificate is for the purchase from CTB Wireless Inc. of the item(s) I have listed in paragraph 5 below.
4. I will resell the item(s) listed in paragraph 5, which I am purchasing under this resale certificate in the form of tangible personal property in the regular course of my business operations, and I will do so prior to making any use of the item(s) other than demonstration and display while holding the item(s) for sale in the regular course of my business. I understand that if I use the item(s) purchased under this certificate in any manner other than as just described, I will owe use tax based on each item’s purchase price or as otherwise provided by law.
Cellular phones, accessories and parts.
For Your Information : A person may be guilty of a misdemeanor under Revenue and Taxation Code section 6094.5 if the purchaser knows at the time of purchase that he or she will not resell the purchased item prior to any use (other than retention, demonstration, or display while holding it for resale) and he or she furnishes a resale certificate to avoid payment to the seller of an amount as tax. Additionally, a person misusing a resale certificate for personal gain or to evade the payment of tax is liable, for each purchase, for the tax that would have been due, plus a penalty of 10 percent of the tax or $500, whichever is more.
Name of purchaser*
Address of purchaser*
Title*
Phone*
Date*
MM slash DD slash YYYY
By clicking submit you are agreeing to the Terms and Conditions.

Credit Card Authorization Form

Alt. Contact

Payment Information

California Resale Certificate