New Customer Application — NEXAutogear B2B

1 — Business Information

Legal Business Name *

Trade / DBA Name

Street Address *

City *

State / Province *

ZIP / Postal Code *

Business Phone *

Business Fax

Business Email *

Federal Tax ID / EIN *

D&B Number (DUNS)

State Tax / Resale License #

Business Type *

Years in Business *

Website

2 — Primary Contact

Full Name *

Job Title *

Direct Phone *

Mobile / WhatsApp

Preferred Language

3 — Trade References (3 Required)

Reference 1

Supplier / Company Name *

Phone *

Fax

Reference 2

Supplier / Company Name *

Phone *

Fax

Reference 3

Supplier / Company Name *

Phone *

Fax

4 — Credit & Terms Request

Terms Requested

Credit Limit Requested (USD)

5 — Product Inquiry

Products of Interest *

Wheels Detail (if applicable)

Size (Dia × Width)

Bolt Pattern (PCD)

Offset (ET)

Finish

Series / Type

Vehicle (Year/Make/Model)

Tires Detail (if applicable)

Tire Size

Category

Brand Preference

TPMS Detail (if applicable)

Sensor Type

Vehicle Application

Quantity

Est. Monthly Volume (USD)

Required By Date

Preferred Shipping

Additional Notes / Special Requirements

6 — Credit Authorization & Personal Guarantee

The undersigned authorized representative of the applicant business hereby certifies that all information provided in this application is true and accurate. Applicant authorizes NEXAutogear and its affiliates to investigate the creditworthiness of the business, including contacting the trade references listed above. Applicant agrees that NEXAutogear retains the right to modify or revoke credit terms at any time. All disputes arising from this agreement shall be governed by the laws of the State of Delaware, USA, without regard to conflicts of law principles. Past-due balances accrue interest at 1.5% per month (18% per annum) or the maximum allowed by applicable law, whichever is less.

Authorized Signature

Print Name & Title

Date

Personal Guarantee: The individual signing below personally guarantees payment of all amounts owed by the above business entity to NEXAutogear, including principal, interest, and collection costs. This guarantee is continuing and unconditional.

Guarantor Signature

Guarantor Name & Home Address

Date

Uniform Sales & Use Tax Exemption / Resale Certificate

Multi-Jurisdiction Form — Complete if purchasing for resale (exempt from sales tax)

Buyer / Purchaser Information

State of Issue *

Seller's Permit / License # *

Type of Business

Description of Property / Services Purchased (for resale)

I hereby certify that the property or services purchased from NEXAutogear will be resold by me in the regular course of my business operations, and that I am entitled to make this purchase without payment of sales or use tax. I understand that if I use this property or service for any purpose other than resale, I will be liable for the applicable sales or use tax. This certificate shall be considered part of each applicable order placed with NEXAutogear.

Authorized Signature

Date