New Customers - Voss Distributing

Please complete the form below to apply for a new account with Voss Distributing. The following files are required. Download links are provided below:

State Tax Exemption Certificate
ACH Form for Voss Distributing

New Account

Date
Date Format: MM slash DD slash YYYY
Account Name*
Visual/DBA name
Complete Account Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name*
Phone Number*
Email Address*
State Retail Tax ID #*
Federal Tax ID #*
Account Classification*
Other Account Classification*
Tax Exemption Certificate*
Accepted file types: pdf.
Download your state tax exemption form here: Iowa Illinois Missouri South Dakota
ACH Form*
Accepted file types: pdf.
Download our ACH form here: ACH Form for Voss Distributing
Consent*
I agree to the terms and conditions:
By signing in the signature box below I agree that I am signing this new account application electronically on behalf of the entity set forth in the Account Name box above (the “Company”) and that I am authorized to bind the Company in connection with this application.

I consent, on behalf of the Company, for such Company to be legally bound by the terms of this application and any other applicable customer terms. I represent that the information provided in this application is complete, true, and accurate.

I further represent that no certification of authority or other third-party verification is necessary to validate my electronic signature and that the lack of such certification or third-party verification will not in any way affect the enforceability of my electronic signature. My electronic signature shall have the same legal validity and enforceability as a manually executed signature or use of a paper-based recordkeeping system to the fullest extent permitted by applicable law, including the federal Electronic Signatures in Global and International Commerce Act (ESIGN) and the Uniform Electronic Transactions Act (UETA) (Iowa Code §554D.101 et seq.). I and the Company waive any defense to the validity or enforceability of this application and any other applicable customer terms or any challenge to the admissibility of this application or customer terms based upon its being electronically signed.

I and the Company hereby release, discharge, and hold harmless Voss Distributing and its officers, directors, employees, agents, and representatives (collectively, the “Released Parties”), from any and all claims for liability, injuries, wrongful death, damages, losses or other claims (including reasonable costs and attorneys’ fees) (each a “Claim”) arising out of or in any way resulting from the Company’s breach of the terms of this Consent and Release.

I HAVE READ THE ABOVE CONSENT AND RELEASE. BY SIGNING, I AGREE THAT IT IS MY EXPRESS INTENT ON BEHALF OF MYSELF AND THE COMPANY TO EXEMPT AND RELIEVE VOSS DISTRIBUTING FROM ANY CLAIM, INCLUDING BUT NOT LIMITED TO CLAIMS FOR DAMAGES, LIABILITY AND INJURY OR WRONGFUL DEATH, AND I CERTIFY THAT I HAVE FULL AUTHORITY TO SIGN THIS CONSENT AND RELEASE.
Signature