Digi Key Account Form – Fill Out and Use This PDF

1-800-344-4539

Tel: 218-681-6674

Fax: 218-681-3380

www.digikey.com

701 Brooks Ave. South, Thief River Falls, MN 56701

03/29/2013

Account Application

AR Phone: 800-338-4105 Ext: 5012

US

AR Fax: 800-338-5135

Digi-Key Use Only

(US & Canada customers only)

Company:

Please print/type all

Account #:

information, sign, and return

Approved Amount:

By:

Date:

Name of Business:

Limit Desired:

Telephone #:

Fax #:

Address:

Dun and Bradstreet #:

City:

State/Province:

Zip/Postal Code:

Country:

Purchase Order # Required (check one)

Yes

No

Billing Address:

Web Address:

Billing Instructions:

Send our invoices via (check one)

Email

Fax

Mail to our billing address

Email address or fax number for invoices:

Send Monthly Billing Statements via (check one)

Email

Fax

Mail to our billing address

Email address or fax number (no extensions) for monthly billing statements:

Accounts Payable email address:

Number of Copies of Invoices:

Current Gross Sales:

Years in Business:

Number of Employees:

Current Net Worth:

Brief Explanation of Business:

President/Owner:

VP Finance/CFO:

Purchasing Manager:

If Subsidiary, Name of Parent Co.:

Address of Parent Company:

TERMS OF SALE

1.Standard terms are Net 30 Days. The undersigned customer is responsible for all fees when wiring funds to Digi-Key. Failure to adhere to our terms may result in a shipping hold on future orders. The net due date is calculated from the date of the invoice. Customer acknowledges that all sales are subject to all terms and conditions as set forth on Digi-Key's website, www.digikey.com. Customer acknowledges that all information collected from or provided by customer may be used in accordance with Digi-Key's Privacy Statement as set forth on Digi-Key's website, www.digikey.com.

2.Should Applicant default in the payment of the outstanding account for monies that are deemed legitimately owed, then Digi-Key shall be entitled to incur expenses for the cost of collection and reasonable attorney's fees and shall be due and owing from the Applicant to Digi-Key.

The parties agree that the state courts of the State of Minnesota and the federal courts in the State of Minnesota have jurisdiction over them and this Agreement, that Minnesota is the appropriate place for venue of any litigation arising hereunder, that all such litigation shall be in Minnesota, and that Minnesota law governs any and all transactions related to this Account.

The validity or invalidity of any portion of these Account Terms shall not invalidate the remainder of the Account Terms which shall remain in full force and effect and shall be interpreted and enforced as if such invalid provision did not appear herein.

The undersigned acknowledges that Digi-Key may create and store a complete image of this document and any related documents, including any signature, in an electronic format (such as read-only CD's), and that any original hereof may be discarded in the ordinary course of Digi-Key's business. The undersigned further acknowledges and agrees that an electronic image or fax of this document and any related documents or any paper copy made from said electronic image(s) or fax shall constitute sufficient evidence of the original for all purposes, including but not limited to any form of dispute resolution proceedings and that the undersigned's signature constitutes an electronic signature pursuant to Minnesota Statutes Chapter 325L.

The undersigned hereby certifies that the information set forth here, together with all other information submitted in connection with this application is true and correct. I understand that Digi-Key will rely on this information in establishing an account for my company and I authorize Digi-Key to contact and obtain information from the references provided. I have read and understand the Terms of Sale and agree that such terms apply to all transactions with Digi-Key.

Signature			Title
Printed/Typed Name			Date