New Account Credit Application

Thank you for your interest in selling Siren Marine products! Please fill out the application below and we will be in touch as soon as possible. Your business is an integral part of our team and we look forward to working with you!

Account Name*

AP Contact Name*

AP Contact Email*

Phone #*

Siren Marine Rep Name (if known)

Select or enter value

Application Type*

If applying for terms, then credit and bank information below is required.

Select or enter value

Billing Address

Where can we send you your invoice?

Address 1 (Street name & number)*

Address 2 (suite, apt, etc)

City*

State/Province*

Select

Zip/Postal Code*

Country

Select

Shipping Address

Same as billing address?*

If so, please choose "Yes" below and skip to the Phone # field.

Select

Address 1

Address 2

City

State

Select

Zip/Postal Code

Country

Select

Sales Tax

Sales Tax Must be collected on any purchases unless a copy of the sales tax or reseller certificate is provided. To attach a certificate, please use the File Uploader at the bottom of this form.

Credit Information

If applying as a credit card account, please skip this section and proceed to signature section below.

How long in business at this address

Tax ID Number

D-U-N-S #

Credit References

If you have a separate credit/bank reference sheet, feel free to skip this section and attach the sheet using the File Uploader at the bottom of this form.

Credit Reference #1

Name

Address Street

City

State/Province

Zip/Postal Code

Country

Phone #

Email #

Credit Reference #2

Name

Address Street

City

State/Province

Zip/Postal Code

Country

Phone #

Email #

Credit Reference #3

Name

Address Street

City

State/Province

Zip/Postal Code

Country

Phone #

Email #

Bank Information

AUTHORIZATION TO RELEASE BANK REFERENCES

By checking this box, I hereby certify that this is my authorization to release information to Siren Marine for the purpose of supporting the credit application & establishing an open credit line.

Bank Name

Bank Account #

Bank Contact Name

Bank Address

Bank City

Bank State/Province

Bank Zip/Postal Code

Bank Phone

Bank Fax

Guaranty

The undersigned Guarantor agrees to be responsible to Siren Marine LLC for payments of all amounts that may be owed to Siren Marine LLC by that stated below and/or his/her assigns and/or successors (heirs).

Guaranty Signature*

By checking this box I agree to the guaranty terms specified below and accept this as my signature.

Printed Name of Guarantor*

Address of Guarantor*

Resale Certificate Upload*

Please attach your resale certificate so we don't charge you sales tax.

Drag and drop files here or

Signature*

By checking this box, I agree to the acknowledgement specified below and accept this as my signature.

Signer's Name*

Please print your name here and check the box below

Acknowledgement

Applicant acknowledges and agrees that if this application is approved by Siren Marine LLC, that the applicant shall abide by the Siren Marine credit policy, requirements and terms. Further, it is acknowledged and agreed that Siren Marine reserves the right at any time, in its sole discretions, to modify the account requirements and/or terms, including the right to cancel the account. Past due accounts are subject to interest at the rate of 1.5% per month on the past due amount. Should it become necessary for Siren Marine to enforce its right to payment on the account by legal process including engaging attorneys who, without suit, assist in the collection of the account, then applicant shall be responsible, in addition, to all other sums owed on the account, for all reasonable attorney's fees and costs sustained.

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