DO YOU HAVE AN EXISTING ACCOUNT WITH A KIMBALL INTERNATIONAL BRAND?

LIST ACCOUNT NUMBER:

COMPANY NAME (LEGAL ENTITY)

DBA (IF APPLICABLE)

STREET ADDRESS

CITY

STATE

ZIP CODE

BILLING ADDRESS (IF DIFFERS FROM ABOVE)

CONTACT INFORMATION

DEALER PRINCIPAL OR PRESIDENT

Must be an authorized signee with your bank

TITLE

PHONE

EMAIL

MAIN POINT OF CONTACT

PHONE

EMAIL

FINANCIAL SERVICES CONTACT

PHONE

EMAIL

SALES MANAGER NAME

EMAIL

MAILING ADDRESS

EMAIL FOR ORDER ACKNOWLEDGEMENTS

EMAIL FOR INVOICES

ADDITIONAL INFORMATION

DO YOU HAVE A PLACE TO DISPLAY PRODUCT (DESIGNATED OR WORKING SHOWROOM)?

DO YOU HAVE SPECIAL WAREHOUSE INSTRUCTIONS FOR DELIVERIES?

SPECIAL WAREHOUSE INSTRUCTIONS

MANUFACTURER ALIGNMENT

TYPE OF BUSINESS

FEDERAL ID#

STATE OF INCORPORATION

TAXABLE OR NON-TAXABLE

Attach sales tax exception certificate for the state(s) in which you are located and a certificate for each of the following states if shipments will be made into any of these states: CA, DC, HI, MA, MD, MS, NY, LA, SD, and TN. A completed multijurisdictional form including the exemption numbers for your state and for all the above states to which you will be shipping is acceptable.

File Upload Size Limit of 25MB

BANK REFERENCE

BANK NAME

ADDRESS

PHONE

SECURED?

TYPE OF SECURITY

TRADE REFERENCE 1

NAME

ADDRESS

PHONE

EMAIL

TRADE REFERENCE 2

NAME

ADDRESS

PHONE

EMAIL

TRADE REFERENCE 3

NAME

ADDRESS

PHONE

EMAIL

ATTACH W-9

File Upload Size Limit of 25MB

TERMS OF ETC. DEALERSHIP
By checking the box below, you agree to the following specific terms applicable to the Etc. Dealer relationship:

Etc. Dealers have access to Etc. brand products, and will not have access to any of Kimball International's other brands, unless specifically authorized in a separate Agreement with Kimball International.
You are not authorized to resell Etc. products through any online channel.
Dock delivery is required for each order and is included in the price of the product.
Registration is open only to Dealerships within the Continental U.S.
Kimball International will obtain independent credit reports and other information from applicant's listed references and banks and will use that information to determine applicant's credit-worthiness.
All invoices are required to be paid promptly and in full. Invoices paid late will be subject to monthly service charges of 1.5% per month or the maximum amount permitted by law, whichever is less.
If Kimball International has to take legal action to collect payment, all collection costs, including without limitation all actual out-of-pocket expenses and collection fees (including collection agency and attorneys' fees) incurred by Kimball International will be the sole responsibility of the Etc. dealer.
You are not authorized to represent your dealership as a Kimball International dealer. Any advertising, marketing or other materials relating to the Dealership that reference Kimball International must do so in conjunction with the Etc. brand, i.e. "Etc. by Kimball International."
Kimball International reserves the right to terminate any Etc. dealer at any time, at the sole discretion of Kimball International.

*

I agree to the Terms of Etc. Dealership listed above

*

Except to the extent modified above, I agree to Kimball International, Inc. Terms & Conditions

*

I agree to the Code of Conduct

NAME OF PERSON SUBMITTING FORM (YOU HAVE LEGAL AUTHORITY TO DO SO)

EMAIL OF PERSON SUBMITTING FORM

TITLE OF PERSON SUBMITTING FORM