1-714-384-1077william.irvin@ingrammicro.com

Will Irvin

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Page 2 of 7

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Page 3 of 7

ion

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Page 4 of 7

Section 3 – Credit Information for Net Terms Request Section 3A, 3B & 3C are required for ALL Net Terms Requests

3A -Financial statements may be required to extend trade credit. You will be contacted if they are needed, or you may include with this application when returned. Please include a minimum of the prior two year’s income statement & balance sheet, and interim financials if available.

Person to Contact for Information or Financial Questions:

Name

Title

Phone

Email

check here if Financial statements are attached to this application

3B – Do you currently finance any of your computer purchases through flooring or leasing programs?

Yes (Complete information below)

NO 1. Finance Company Name

Dealer #

Finance Company Telephone Number

2. Finance Company Name

Dealer #

Finance Company Telephone Number

3C – Trade & Bank References Check here if you have attached a separate trade and bank reference sheet rather than completing below

(Additional sheet must be signed)

Trade References (Preferably in the Computer Technology Industry)

1. Company Name

Company Phone #

Company Fax #

Account Number

Contact Name

2. Company Name

Company Phone #

Company Fax #

Account Number

Contact Name

Section Bank R

Bank N

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______Owner/P ______Owner/P

3C- Con’t Reference

Name

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gs Account #

f Credit Accoun

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on 4 – Export Iny of your purc

, Please complemation. Both ofyou intend to p

ate Internationnformation on

cation and agreemves the right to der to change or revopplicant’s failure toales by DBL Distribon DBL Distributin

t or ders a s publis hs will be effective oomer marketing af Ingram Micro Incicro Inc., as interesany such paymentDBL Distributing Dnable attorney(s) fal and is not transfurred to DBL Distri., until D BL Distri bd, and enforced unother jurisdiction. V

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ete and submitf these documepurchase produnal Fulfillment Ace your accoun

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Division of Ingram Mfees, court costs, aferable or assignabbuting Division of buting D ivision of nder and in accordaVenue shall be in O

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munications f rom t idue according to Dal to 1 ½% per mong Division of IngrMicro Inc. should coand other expensesle without prior wrIngram Micro Inc. Ingram Mi cro Inc

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foregoing andy the referencThe following

____________Please Print (Req

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TO DELAY YOUREQUESTED. CCOUNTS THAOUR SYSTEM.

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stablished by DBL Do applicant will be sebsite at www.dbldIngram Mic ro In c

tributing Division ome to t ime v ia v a

DBL Distributing Divonth, or the maximram Micro Inc. shalommence any actios incurred by DBL Ditten consent of DBdue to a ch ange

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Page 5 of 7

NO

with this appliww.dbldistributinstributing Divisuired. Contact

on of Ingram Microended to applicant,not limited to, credDistributing Divisiosubject to DBL Distdistributing.com/x/tc. we bsite at wwwof Ingram Micro Incarious means, incl uvision of Ingram Mmum provided by lall have the right, won or actions, or otDistributing DivisionBL Distributing Diviin customer’s formnotice of the cha n

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ABILITY, PLEAS

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o Inc. (DBL) to obt, DBL Distributing Ddit policy changes bon of Ingram Microributing Division ofterms at the time w.dbldistributing.coc. prior to the time uding e-mail. Custicro Inc. invoice(s)

aw (whichever is lewithout notice to cutherwise seek to enn of Ingram Micro sion of Ingram Mic

m of business, shallnge by cert ified m

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s financial conditioicant’s utilization o. Standard Sales Teterms and conditio

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Page 6 of 7

STOP: IMPORTANT TAX INFORMATION – Resale Tax

DBL Distributing Division of Ingram Micro Inc. is a distributor/wholesaler. To establish and maintain your account, we require that you provide us with a Resale Certificate valid in the state where you are located, as well as any other state in which you are regi stered, and that you update your certificate(s) on a periodic basis in a ccordance with state laws and/or DBL Distributing Division of Ingra m Micro Inc. policy. Our Resal e Tax Department will notify you by mail wh en an updated certificate is req uired. Failu re to pro vide an upda ted certificate may result in delayed shipments, rejection of your orders, and/or the closure of your account. Orders that are drop-shipped may be subject to sales tax if you have not provided DBL Distributing Division of Ingram Mi cro Inc. a Resale Tax Certificate for the ship-to location. The Resale Certificate must include: 1. Legal business name 2. Business trade name(s); DBA 3. Business address and phone number 4. Type of business as registered with your state 5. General description of business 6. State sales registration number of each state in which you are licensed for resale 7. Signature of owner or officer signing application 8. Name and title of person signing certificate 9. Date certificate is signed Along with your state registrations you are required to provide the following forms/information if you ask to drop ship to the following states: New York Every customer must complete a New York ST-120 Resale Certificate Part 1 or Part 2 as applicable Pennsylvania Every c ustomer mu st com plete a PA REV 1220. If your company does not have a

Pennsylvania Sales Tax number due to not having nexus in PA, please complete the PA REV 1220 and include the company's home state tax ID, the state registered in and an explanation on line 7 as to why not registered. Example "no nexus"

Illinois If your company is not required to be registered in Illinois due to lack of nexus in the state, please indicate "no nexus" on the Illinois line of the Uniform Sales & Use Tax Certificate- Multijurisdiction form. PLEASE NOTE: DBL Distributing Division of Ingram Micro Inc. has special sales tax requirements for shipment to the following 3 States and sales tax will be applied to all shipments to those states unless the stated information is provided. California A resale certificate with valid California tax ID number. Massachusetts A Massachusetts state specific ST-4 Resale certificate that includes a valid Massachusetts

tax ID number. Tennessee A resale certificate with a valid Tennessee tax ID number.

If you have any questions, please contact your Sales Representative or Resale Tax Department prior to requesting Ingram Micro to ship to any of these 3 States. If a state in which you are registered for resale does not accept the attached Uniform Sales & Use Tax Certificate-Multijurisdiction, please call our New Accounts Department at (800)456-8000, ext. 41 to obtain the appropriate form.

Page 7 of 7

UNIFORM SALES & USE TAX CERTIFICATE – MULTIJURISDICTION

The below-listed states have indicated that this form of certificate is acceptable, subject to the following notes. The issuer and the recipient have the responsibility of determining the proper use of this certificate under applicable laws in each state, as these may change from time to time. Issued to Seller: DBL Distributing Division of Ingram Micro Inc. Address: 1759 Wehrle Drive Williamsville, NY 14221 I certify that:

Name of Firm: _____________________________________________ DBA Name: __________________________________________ (Required Name of Firm) (Required if Using a DBA) Is engaged as a registered: (Required -- Please check all that apply)

Lessor (See Notes) Manufacturer Retailer Seller (California) Wholesaler Other ____________________________________

Street Address: ____________________________________ City, State, & Zip: _________________________________________________ (Required Street Address) (Required City, State & Zip)

and is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases are for wholesale, resale, ingredients, or components of a new product or service to be resold, leased, or rented in the normal course of business. We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following:

Description of business: ________________________________________________________________________________________________ (Required Description of business) General description of tangible property or taxable services to be purchased from the seller: Computer hardware, software, and/or related items You are required to complete the following for all state(s) in which you are registered unless it is not listed or a state specific form is required as outlined below. Click here for instructions 1-21 regarding Uniform Sales Use Tax Certificate Alaska, Delaware, Montana, New Hampshire, & Oregon do not require a resale certificate, but we do require this form be completed, with the exception of the tax number, to serve as documentation that product purchased from Ingram Micro is for resale:

State

State Registration, Seller’s Permit, or ID Number of Purchaser

State

State Registration, Seller’s Permit, or ID Number of Purchaser

State

State Registration, Seller’s Permit, or ID Number of Purchaser

Alabama 2 Louisiana USE R1064 or R1055 FORM Ohio 26 Arizona 22 Maine 9 Oklahoma 16 Arkansas Maryland 10 Pennsylvania California 3 Massachusetts USE ST-4 FORM Rhode Island 17 Colorado 1 Michigan 11 South Carolina Connecticut 4 Minnesota 12 South Dakota 18 Dist. of Columbia 5 Mississippi Tennessee Florida 23 USE DR-13 FORM Missouri 13 Texas 19 Georgia 6 Nebraska 14 Utah Hawaii 1, 7 Nevada Vermont Idaho New Jersey Virginia USE ST-10 FORM Illinois 1, 8 New Mexico 1, 15 Washington 20 USE RESELLER PERMIT FORM

Indiana USE ST-105 FORM New York USE ST-120 FORM West Virginia USE STREAMLINE FORM Iowa North Carolina 25 Wisconsin 21 Kansas North Dakota Wyoming USE STREAMLINE FORM Kentucky 24

further certify that if any property or service so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax, we will pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be a part of each order, which we may hereafter give to you, unless otherwise specified, and shall be valid until cancelled by us in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter. Authorized Signature (Required): ___________________________________________________ (Owner, partner, or corporate officer) Title: (Required)__________________________________________ Date: __________________________(Required) *State specific forms may be downloaded from our website www.dbldistributing.com/ with the following exceptions: for a Florida DR-13 form, please contact the Florida Department of Revenue at 941-361-6001; for a New Mexico form, please contact the New Mexico Taxation and Revenue Department at 505-841-6200. If you have any questions, contact the New Accounts Department at 1-800-733-6766.

Account Number (For Office Use Only)