PRIME MOUNTINGS INC.

Know Your Customer (KYC) Wholesale Application

Dear Business Partner,

Prime Mountings Inc. maintains an anti-money laundering (AML) program in line with the requirements of the USA PATRIOT Act. To open a wholesale account and receive trade pricing, please complete, sign, and return this KYC form.

Please email the completed form to [email protected]. If you have any questions, our support team is happy to help.

Thank you for helping us keep a secure and compliant business relationship.

Sincerely,
The Prime Mountings Inc. Team

Registered Address*

Street addressStreet address line 2CityState / ProvincePostal / ZIP code

California businesses: after submitting this form you will also need to complete a California Resale Certificate and email it to [email protected].

Alternate Addresses

Business Address (if different)

Street addressStreet address line 2CityState / ProvincePostal / ZIP code

Postal / Mailing Address (if different)

Street addressStreet address line 2CityState / ProvincePostal / ZIP code

Business Details

Year Company Established*How Long at Location by This Owner*Type of Company*WebsiteDirectors / Owners of CompanyFull names, separated by commas

Contact Information

Contact PersonEmail AddressPhone Number

Tax & Compliance

Company Resale Number*Resale Permit Number*

Is this company AML (Anti-Money Laundering) compliant pursuant to the USA PATRIOT Act?*

YesNo

Confirmation

1. I confirm that the details above are true and correct.*
2. I confirm that I have provided, or will provide, all required documentation.*
3. I agree to notify Prime Mountings Inc. of any changes to these details.*
4. Where applicable, I confirm that I have disclosed all relevant information.*

Name*Title*Signature*Type your full name to signDate*