KVH Dealer Credit Application

When you transmit personal information via this web form to KVH Industries, Inc., your personal information is protected through the use of encryption, such as the Secure Socket Layer ("SSL") protocol. SSL makes it difficult for your personal information to be intercepted or stolen while being transmitted. KVH uses a service company to process its credit card transactions. For further information on this company's privacy and security practices, please click here.

ALL form fields are required unless otherwise specified.

Are you a mass merchant associated with an existing KVH account?     Yes No
Type of dealership being applied for:

Company Information
No. of years in business:    No. of years at this location: Organization Type:
State Incorporated in:    Year:
Tax Status:    No.:
Do you have a D&B Number?   No   Yes   If yes:
Officers or Principles:
Accounts Payable Contact:
Authorized Buyers:
E-Mail:    Check this box if e-mail is not to be listed on KVH website
Website: This field is NOT required. KVH will link to your website on our "Where to Buy" page.

Billing Information
Company Name:
 Billing Address:
Primary Contact:
 City:
DBA:  (Same as Company Name)
Country:   State:   Zip:

Phone #: (111-111-1111)
Fax #: (111-111-1111)

Shipping Information
No. of retail locations: Please include addresses of all applicable shipping locations.
Same as billing info
Shipping Address:
 City:

Country:   State:   Zip:
Phone #: (111-111-1111)


The following information must be completed for all net 30 and credit card term applicants:

Bank Reference
If your company has a standard bank and credit reference form, you may fax it to KVH. Please check the box below:

Bank/Credit references faxed to 1-401-845-8190, attn: Amy Rocha

Bank Name:
Account # :

Phone #: (111-111-1111)

Credit References
Company 1:
Account # :

Phone #: (111-111-1111)
Fax #: (111-111-1111)

Company 2:
Account # :

Phone #: (111-111-1111)
Fax #: (111-111-1111)

Company 3:
Account # :

Phone #: (111-111-1111)
Fax #: (111-111-1111)

 



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