Are you interested in doing business with KSS Enterprises? Fill out the form below or call KSS Enterprises at 269.349.6637 so we can begin working with you today!For a downloadable version click here. "*" indicates required fields Step 1 of 7 14% Company NameCompany Name (as it appears on your tax return)* DBA Name KSS Sales Representative's Name* First Last KSS Sales Representative's # (if known) Billing InformationName* First Last Email* Enter Email Confirm Email Email Order Confirmation* Yes No Phone*FaxBill-To Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Shipping InformationIs the Shipping Address the same as the Billing Address?* Yes No Do you have multiple Shipping Addresses?* Yes No File*(for multiple Shipping Addresses, please upload a separate document listing all locations)Accepted file types: pdf, doc, docx, xls, xlsx, rtf, txt, jpg, png, Max. file size: 128 MB.Office Contact* First Last Email* Enter Email Confirm Email Email Order Confirmation* Yes No Phone*FaxShipping Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Purchasing InformationName* First Last Email* Enter Email Confirm Email Email Order Confirmation* Yes No Phone*FaxWould you like to be set up for online ordering?* Yes No I/We request our invoices to be sent via:* Email Fax Please provide Email Address* Enter Email Confirm Email Please proved Fax #* Delivery Contact InformationPlease provide the following information requested for delivery purposes.Receiving Hours* Signature Required Upon Delivery?* Yes No May we leave product if nobody is there?* Yes No If yes, where should we leave the product?* Do you close due to bad weather?* Yes No If yes, may we still deliver?* Yes No Who do we contact if closed?Name* First Last PhoneOn occasion, we may need to reach you for delivery verification. Receiving Contact #1Name* First Last Phone*Receiving Contact #2Name First Last PhoneWho should receive the delivery email confirmation? Contact #1Name* First Last Email* Contact #2Name First Last Email Special Instructions for Receiving: Additional InformationPresident* First Last Vice President* First Last Owner* First Last Manager* First Last Type of Business* Years in Business*Are you Tax Exempt?* Yes No File*Please attach a Certificate of Exemption form. Taxes will be applied to all orders pending receipt of this form.Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 128 MB.Bank Name* Bank Contact Name (if known) First Last Phone*FaxAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Routing Number*Please enter a number from 9 to 9.Account Number* Credit ReferencesReference #1Name* First Last Phone*Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference #2Name* First Last Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent & SignatureKSS Enterprises accepts the following payment forms: cash, check, or ACH. If you choose to pay by credit card, a 3% convenience fee will be applied.KSS Enterprises Terms & Conditions*PLACING ORDERS: • For your convenience, orders may be placed by phone, fax, and email or through our Customer Service Remote (On-Line Order Entry). ORDER DEADLINE: • A 12:00 p.m. cut off time for order placement is applicable on orders scheduled for next day delivery. MINIMUM ORDER: • All orders less than $250.00 will be assessed a $10.00 handling charge. • Orders picked up by customers are excluded. RETURN POLICY: • A Return Goods Authorization (RGA) number must be obtained prior to the return of any product. This number must be visible on the package before KSS Enterprises will credit a return. Please obtain an RGA by calling you Account Coordinator, Sales Consultant, or the phone number of the location nearest you. • No credit will be extended for any quantity greater than the amount purchased. • We are pleased to order any product for you that we do not stock. Full case quantities must be ordered. All Special Orders are non-returnable and non-refundable. • No returns will be accepted after 60 days from invoice date. Claims for damaged product must be reported to KSS within 48 hours after delivery. • All returns are subject to review before credit is issued. A re-stock fee, including freight, may apply. Terms: • Terms are Net 30 Days - Late Fee 1.5% per month. • There will be a $25.00 service charge for all returned checks. • Applicant aggress to pay the total amount due each on invoice from KSS Enterprises in accordance with the payment terms thereon, unless otherwise agreed upon in writing. If not paid when due, Applicant agrees to pay a service charge of 18% annum (1.5% per month) ot the highest rate allowable by law. Applicant agrees to pay all costs and expenses of collection (whether or not suit is filed), including reasonable attorney fees incurred by KSS Enterprises in litigation, appeals, bankruptcy proceedings, or otherwise. • Applicant and KSS Enterprises agree that any disputes between the parties arising out of their business relationship shall be resolved by the appropriate state district, state circuit, or federal court located in the city of Kalamazoo, Michigan and that said venue(s) shall be exclusive venue(s) to resolve such disputes. SALES TAX: • Until we receive a certificate of exemption form, all customers will be considered taxable. I/We understand the above Terms & Conditions, and that invoices and monthly statements will be the only notice that payment is due. I/We also understand and agree to pay the standard legal collection fees required to obtain payment if account becomes delinquent.Name* First Last Title* Date MM slash DD slash YYYY Signature*CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
