New Account Information

To set up a new account with Bell-Mark, please complete all applicable fields. Your request will be processed shortly, and you should receive a reply from our Customer Service department.
* required fields for processing

I. Applicant Information
Company Name *	Tax ID/SSN

Billing Address *

Billing City *	Billing State

Billing Zip *	Billing Telephone *

Billing Fax	Type of Business

E-mail *


Shipping address is the same as billing
Shipping Address

Shipping City	Shipping State

Shipping Zip	Shipping Telephone


Tax Exempt ?	If yes, Tax Exempt Number


II. Bank Reference
Bank Name

Address

City	State

Zip	Telephone


III. Trade References
Name

Address

City	State

Phone	Contact


IV. Terms and Conditions
1. Payment Terms. Bell-Mark credit terms are Net 30 Days. Interest of 1.5% per month (or the maximum amount permitted by law) may be charged on past due amounts beginning the 31st day following the invoice date. In the event of non-payment of any invoice, the undersigned agrees to pay collection fees, attorney fees, and court costs incurred in enforcing the terms of any invoice. Credit granted to the undersigned may, at Bell-Mark's option, be cancelled at any time with or without notice. Bell-Mark may discontinue or suspend service at any time without incurring liability. 2. Liability/Warranty. With respect to claims or suits by Customer, its customers, or any others, for damages relating to or arising out of acts or omissions under this Agreement, Bell-Mark's liability under this Agreement shall not exceed the total amount paid to Bell-Mark hereunder in the latest three months of the Agreement prior to the claim. Bell-Mark shall in no event be liable for (i) loss of profits, use, data or other intangibles, (ii) incidental, special, punitive or consequential damages suffered by Customer, Customer's customers, or any other persons or entities and relating to or arising out of the services to Customer, (iii) failure to perform any other obligation this Agreement including, but not limited to, temporary service interruptions or (iv) for any act or omission of any other entity furnishing any portion of the services provided to Customer, even if Bell-Mark has been advised of the possibility of such damages. In the event of a technical problem in the services to Customer, Bell-Mark may provide a credit to Customer, as it deems appropriate. Otherwise, Bell-Mark MAKES NO REPRESENTATION OR WARRANTY EITHER EXPRESS OR IMPLIED REGARDING THE SERVICES TO CUSTOMER, AND SPECIFICALLY DISCLAIMS ANY IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. The provisions of this paragraph apply while this Agreement is in effect and after its termination. 3. Indemnity. Customer will indemnify and hold Bell-Mark harmless from and against all losses, damages, liabilities, costs, charges and expenses, including reasonable attorneys' fees, arising from Customer's violation of this Agreement. For purposes of these "Terms and Conditions", "Bell-Mark" includes entities that furnish any portion of the services provided to Customer or its customers. 4. Entire Agreement. This Agreement constitutes the entire agreement of the parties and supersedes all prior discussions or agreements, whether written or oral, including but not limited to any advertising, brochures, or solicitations. Any modification or change to this Agreement must be in writing signed by Bell-Mark.

I agree to the Terms and Conditions above.