Dealer Application ALL FIELDS MANDATORY COMPANY NAME * EMAIL ADDRESS * PHONE * FAX * BILLING ADDRESS Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands 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Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country USE SAME ADDRESS FOR SHIPPING USE SAME ADDRESS FOR SHIPPING SHIPPING ADDRESS Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country PLEASE LIST OWNERS NAME AND ALTERNATE CONTACT OWNER FIRST NAME * LAST NAME * ADDITIONAL CONTACT * TITLE * DATE COMPANY STARTED * HOW MANY TECHNICIANS DO YOU HAVE? * TRADE REFERENCE-PLEASE PROVIDE A BUSINESS REFERENCE COMPANY NAME * CONTACT NAME * ADDRESS * PHONE * FAX * AUTHORIZATION PLEASE SIGN WITH YOUR FULL NAME AS YOUR DIGITAL SIGNATURE TO AUTHORIZE THIS ACCOUNT SETUP: * TERMS AND CONDITIONS PAYMENT TERMS Jonari Corporation dba WALD USA Terms of Payment are: Cash, Credit Card, or C.O.D. (upon approval). *COD terms are guaranteed funds only. All goods remain property of Jonari Corporation until paid in full.New Account Policy: Jonari Corporation requires that new accounts must pay in full by wire transfer for the first $10,000.00 in orders. International Accounts: Payment is by wire transfer in full only. In the event the account is collected by suit or otherwise, the customer will pay the attorney fees. Returned checks: There will be a $25.00 fee for each returned check. CLAIMS/RETURN OF MERCHANDISE Within 5 days after the receipt of each shipment, any shortage, wrong parts, concealed damage etc. discovered must be reported to a Jonari Corporation. All items to be returned must have an Authorization Number issued by a Jonari salesperson and must be shipped prepaid within 10 days of receipt of the Authorization Number. NO PARTS WILL BE ACCEPTED OR STOCK RETURN BEYOND 60 DAYS FROM THE DATE OF PURCHASE. The returned merchandise must be accompanied by the original invoice or and be unused, resalable and still in the original, undamaged package. There are no returns accepted on Special Orders. Special Orders are items which Jonari Corporation does not stock. Shipments not meeting these requirements will be returned to sender. A minimum Restocking Fee of 15% will be charged for returns resulting from customer error. Defective items will be replaced or credited. However, we will not guarantee parts which became defective due to improper installation or if they are used in any other manner not intended by the manufacturer. MOTORSPORT AND OFF-ROAD DRIVING IS DANGEROUS AND MAY RESULT IN SERIOUS INJURY OR DEATH. JONARI CORPORATION DECLINES ANY RESPONSIBILITY ON CLAIMS OR CONSEQUENTIAL DAMAGES RESULTING FROM PARTS SUPPLIED AND INSTALLED FOR OFF-ROAD OR RACING PURPOSES. THE PURCHASER OF THESE PARTS ASSUMES ALL LIABILITY AND SHOULD COMPLY WITH LOCAL, STATE AND FEDERAL LAWS. All sales are F.O.B. point of shipment. The customer must make claims for damage or loss of merchandise resulting from handling during transportation directly with the delivery carrier. Checkboxes * I AGREE TO THE TERMS AND CONDITIONS. reCAPTCHA Submit