Customer Application Form

Personal Information

First Name

Last Name

Email

Phone

Business Information

Business Legal Name

DBA

Street

City

State

Zip

Phone

Fax

Purchasing Agent Name

Email

Is shipping address different than billing?

Yes, shipping address is different

Shipping Information

Name

Street

City

State

Zip

Phone

Email

Is shipping address different than billing?

Yes, shipping address is different

Payment & Business Details

Payment Terms

ACH Credit Card CBD (May be required based on credit)

PAYMENT TERMS & CONDITIONS:

All invoices must be paid pursuant to the selected payment method.
Discounts will NOT be allowed on new invoices if older invoices are unpaid.
A finance charge of 1.5% per month will be charged on past due payments.
If collection efforts are necessary to collect past due amounts, the customer agrees to pay all legal and collection fees for such collection efforts.
Customer authorizes Solstice/Jamison to make inquiries into the banking and trade references provided and to make periodic credit checks.
Signature below is an acceptance of the terms and conditions set forth in this Payment Options form and confirmation that Customer has read and understands such terms and conditions.

Business Type

Corporation Partnership Sole Proprietorship Non-profit

Premises

Own Rent

Date Business Started

Federal EIN

DUNS #

Owners and Partners

(If a Corporation; President, Treasurer and Secretary names)

Name

Position

Common: President Treasurer Secretary Partner Owner CEO CFO Manager

ACH Authorization Form

This authorization allows Solstice/Jamison to process ACH payments from your bank account.

Company Name

Name of Bank

Bank Routing/Transit # (9 digits)

Bank Account #

Bank Account Type

Checking Savings

Please Choose Authorization Type:

It is understood that if there are past due invoices on your account you are not qualified for an early payment discount.

One-time authorization - I authorize Solstice Sleep Products, Inc. to charge my account for a specific amount Recurring authorization - I authorize Solstice Sleep Products, Inc. to charge the above amount for charges based on "Unpaid Invoices" within 72 hours of the invoice issuance date as agreed upon for the purpose of earning the three percent (3%) early payment discount. ACH Payment processing will be conducted every day of the week.

I acknowledge that I am an authorized signer of the above account. This authorization remains in effect until Solstice has received written notice of its termination and with the understanding that without this Authorization, the Customer will not be eligible to receive the standard early payment discount.

Print Name

Position

Common: President Treasurer Secretary CEO CFO Owner Partner Manager

Signature

Date

*** A voided check will need to be attached to the final authorization form ***

📄 Download Authorization Form

Generate a PDF version of this authorization form with your entered information.

Note: The downloaded form will include all information you've entered. Print, sign, and attach a voided check before submitting.

Credit Card Authorization Form

This authorization allows Solstice/Jamison to process credit card payments.

Company Name

Name on Card

Credit Card Billing Address

City

State

Zip

Credit Card Information

Credit Card Type

Visa Mastercard American Express Discover

Card Number

Exp. Date

CVV2 (3 or 4 digits)

Please Choose Authorization Type:

One-time authorization - I authorize Solstice Sleep Products, Inc to charge the above credit card for a one-time payment. There is a 2% handling fee for processing the credit card. Recurring authorization - I authorize Solstice Sleep Products, Inc to charge the above credit card for charges as agreed upon with prior notice for each transaction. There is a 2% handling fee for processing the credit card.

I acknowledge that I am an authorized signer of the above account. This authorization remains in effect until Solstice has received written notice of its termination and with the understanding that customer will not be eligible to receive an early payment discount with credit card payments.

Print Name

Position

Common: President Treasurer Secretary CEO CFO Owner Partner Manager

Signature

Date

📄 Download Authorization Form

Generate a PDF version of this authorization form with your entered information.

Note: The downloaded form will include all information you've entered. Print and sign before submitting.

Sales Tax Exemption

Upload your sales tax exemption certificate if applicable.

Tax Exemption Status

Our business is exempt from sales tax

About Sales Tax Exemption

If your business is exempt from sales tax, please upload a copy of your valid tax exemption certificate. This certificate must be issued by the appropriate state tax authority and be current.

Common exemption types include:

Resale: Items purchased for resale to end customers
Manufacturing: Raw materials used in manufacturing processes
Non-profit: Qualified non-profit organizations
Government: Federal, state, and local government entities

Uniform Sales & Use Tax Exemption/Resale Certificate — Multijurisdiction

The below-listed states have indicated that this certificate is acceptable as a resale/exemption certificate for sales and use tax, subject to the notes on pages 2-4. The issuer of this certificate is responsible to determine the proper use of this certificate under applicable laws in each state, as these may change from time to time.

Issued to Seller

Address

I certify that:

Name of Firm (Buyer)

Address:

Street

City

State

Zip

Business Type

General description of tangible property or taxable services to be purchased from the Seller

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

I further certify that if any property or service so purchased tax free is used or consumed 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 that we may hereafter give to you, unless otherwise specified, and shall be valid until canceled 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:

⚠️ DIGITAL SIGNATURE REQUIRED ⚠️
Click here to sign and save your signature

Authorized Signature
The purchaser hereby certifies that the above information is correct and that the purchaser is authorized to execute this certificate.

📝 Click to open and save signature (Required to proceed)

* You must click, sign, and save your signature to continue

Title

Common: President Treasurer Secretary Partner Owner CEO CFO Manager

Date

Authorization

Signature below is authorization for Solstice/Jamison to make credit inquiries regarding Customer and is certifying that information on this application is true and correct.

I authorize Solstice/Jamison to make credit inquiries and certify that all information provided is true and correct.

Print Name

Position

Common: President Treasurer Secretary Partner Owner CEO CFO Manager

⚠️ DIGITAL SIGNATURE REQUIRED ⚠️
Click here to sign or view your existing signature

Signature below is authorization for Solstice/Jamison to make credit inquiries regarding Customer and is certifying that information on this application is true and correct.

📝 You MUST click here to proceed (Required)

Customer Application Form

Personal Information

Business Information

Shipping Information

Payment & Business Details

PAYMENT TERMS & CONDITIONS:

Owners and Partners

ACH Authorization Form

Please Choose Authorization Type:

📄 Download Authorization Form

Credit Card Authorization Form

Credit Card Information

Please Choose Authorization Type:

📄 Download Authorization Form

Sales Tax Exemption

Upload Requirements

About Sales Tax Exemption

Uniform Sales & Use Tax Exemption/Resale Certificate — Multijurisdiction

I certify that:

Address:

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

Authorized Signature:

Authorization

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PRODUCTS

SUPPORT

COMPANY

Customer Application Form

Personal Information

Business Information

Shipping Information

Payment & Business Details

PAYMENT TERMS & CONDITIONS:

Owners and Partners

ACH Authorization Form

Please Choose Authorization Type:

📄 Download Authorization Form

Credit Card Authorization Form

Credit Card Information

Please Choose Authorization Type:

📄 Download Authorization Form

Sales Tax Exemption

Upload Requirements

About Sales Tax Exemption

Uniform Sales & Use Tax Exemption/Resale Certificate — Multijurisdiction

I certify that:

Address:

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

Authorized Signature:

Authorization

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PRODUCTS

SUPPORT

COMPANY