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Credit Application Form - KVH Europe A/S

Talented dealers and distributors are critical to KVH’s success and the satisfaction of our customers around the globe. If you are interested in becoming an authorized KVH dealer or distributor and purchasing product directly from KVH, please complete the credit application form below. A member of the KVH financial team will review your application after which a member of KVH’s Sales Department or your local KVH sales representative will be contacting you. For information on our privacy and security practices, please click here.

Indicates a required field

Type of dealership being applied for

Company Information

Company

Number of years in business

Number of years at this location

Number of Employees

Organization Type

State/Province/Region/Country Incorporated in

Year Incorporated in

Do you have a Dun & Bradstreet Number?

Yes
No

VAT # (only applicable for EU-countries)

Share Capital EUR

Total Equity Capital EUR

Officers or Principles

Accounts Payable Contact

Authorized Buyers

E-mail

Check this box if e-mail is not to be listed on KVH website

Website

This field is NOT required. KVH will link to your website on our "Where to Buy" page if filled in.

Billing Information

Primary Contact

Billing Address

Billing City

Billing Country

Billing Region

Billing Zip/Postal Code

Billing Phone

Billing Fax

Shipping Information

Number of retail locations

Please include addresses of all applicable shipping locations

1. Shipping Address

Shipping City

Shipping Country

Shipping Region

Shipping Zip/Postal Code

Shipping Phone

Trade References

1. Company

Country

Contact Name

E-mail

Phone

Fax

2. Company

Country

Contact Name

E-mail

Phone

Fax

The following information must be completed for all net 30 and credit card term applicants

Bank Reference

Bank Name

Bank Branch

Bank Country

Account #

Bank Phone #

Bank Fax

Credit References

1. Company

Account #

Phone

Fax

2. Company

Account #

Phone

Fax

3. Company

Account #

Phone

Fax

Anticipated Yearly Turnover with KVH EUR

Anticipated Yearly Turnover EUR, Total

Credit Requested (EUR)

We certify that all of the information on this ofrm is correct. We understand that the information on this form is for the purpose of obtaining credit from your firm. We agree to the proper payment in consideration of extended credit. The undersigned agrees to pay all collection costs, court costs, and legal fees incurred to collect delinquent balances.

Authorized Signature 2/11/2012

Credit Application Form - KVH Europe A/S

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