DIVCMA ApplIcation This is the application form any prospective company should use to request consideration to join the DIVCMA. Company Information:All information supplied herein is considered confidential and will be used to ensure applicant company meets the criteria to join the DIVCMA. Company Name*DBA/Trade NameIs your company a member of any other Credit Association? (Yes/No) If yes, please note with which association)*Is your company a member of any other trade groups? If so, please list them and who facilitates them:*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Website (https://www.XXXX.com)* Company's Fiscal Year End (MM/DD)*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Federal Employment ID (FEIN): xx-xxxxxxx*Federal Employment ID number used for filing tax returns. If from a non-US country, provide your government id number.Year Business Established*Legal Structure*CorporationS CorpProprietorshipPartnershipLLCOwnership Type*Publically TradedPrivately HeldCompany A/R System*SAPOracleEclipseMAS90PeachtreePeopleSoftCforiaQuickbooksGetPaidSungardWorkflow AREpicorSpruceware.netCreditPointeHigh RadiusDynavisticsTermSyncForsevaCMSBilltrustCustomOther:Number of Customer Accounts*Sales Region*New England AreaNortheastern USNationallyInternationallyAnnual Revenues*$5 mil - $9.99 mil$10 mil - 19,999 mil$20 mil - $49,999 mil$50 mil - $99,999mil$100 mil - $149,999 mil$150 mil - $199,999 mil$200 mil or aboveImporter/Exporter of Goods & ServicesImporterExporterImporter & ExporterNot ApplicableType of Business*ManufacturerWholesalerDistributorService ProviderRetailerFinancial ServicesOtherSIC Code/NAICS Industry Classification Code (if unknown, please enter 0000)*Please list the business types/industries/channels you sell to/service:Products & Services Sold*Please provide your top 5 customers (Names, City, State): Please list your top 5 competitors:Does your company submit A/R electronically to any credit bureaus or reporting agencies?YesNoHow did you learn about DIVCMA? Current customer referral Other DIVCMA is associated with BCI, a provider of credit services. Please check off any services you'd like to learn more about: Select All Commercial/International Credit Reports Consumer Credit Reports Credit Reference Checking and/or Application Processing Services Industry Trade Exchange Credit Group Special Interest Groups Commercial Collections/Recovery Services Credit Education & Professional Certification Programs Employment Services Credit Policy Consultancy Qualification Questions: Applicant company is engaged in the sale of beverages to the alcoholic beverage distributor network?* Yes No Applicant company employs a full-time management level financial executive responsible for the credit function?* Yes No Applicant company's distribution network is national in scope?* Yes No Applicant company has minimum annual sales of $50 million which can be verified by case sales, financial statements and/or an attestation letter from applicant's CFO if verification is deemed necessary?* Yes No Applicant company is related through association, affiliation, control or ownership to an alcoholic beverage wholesale distributor which sells any of applicant company's products?* Yes No DIVCMA members are required to submit and respond to trade credit references from other DIVCMA members in accordance of the BCI Trade Credit Exchange Code of Conduct. Applicant company agrees to comply with submissions, responses and adherence to the BCI Trade Credit Exchange Code of Conduct?* Yes No My company will not allow sharing of customer trade reference information. Company Contacts: Financial Officer/Controller Name**Financial Officer/Controller Email* AP Contact Name:**AP Contact Telephone:*AP Contact Email:* Applicant Company's Designee:Terms and Conditions The DIVCMA Bylaws govern what companies are eligible to join the Association. Any company interested in joining must complete a DIVCMA Application which will be confidentially reviewed by a third party compliance facilitator. If your company meets the DIVCMA Bylaw Membership Criteria, you may attend one meeting to determine if your company would beneift from our Association. Once you notify DIVCMA of your intention to pursue Membership, your Application will be processed, an invoice will be sent to you and when payment is received in full, your access to DIVCMA and BCI services will be activated. Once my company joins, I understand that company fees for products and services are due upon invoice. Annual service fees for DIVCMA members are set at the prevailing rates, are subject to change and continue from year-to-year unless notice of cancellation in writing is given at least 30 days in advance of annual renewal date and that my company is responsible for such charges. I understand that there are no refunds, including fees for unused services. Any amount past due is subject to a monthly 1.5% finance charge. The applicant hereby agrees to pay interest or late charges on all unpaid invoices for products and services from the date due until all sums are paid in full, at the lesser of one and one half percent (1-1/2%) per month, compounded monthly, or at the highest contract rate allowed by law. All costs of collections, before and after judgment, including but not limited to court costs, interest and reasonable attorney fees. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age: because all or part of the applicant’s income devices from any public assistance program: or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission. The applicant certifies that the statements contained in the application are accurate, that he/she will abide by DIVCMA and BCI Trade Credit Exchange Code of Conduct, and that he/she has the authority to execute this agreement on behalf of the applicant company.I received a copy of the DIVCMA bylaws and the BCI Trade Credit Exchange Code of Conduct and agree to the Terms & Conditions set forth above?* Yes No Signature / Title*Professional Designation:Years in Credit Profession:*# of Credit & Collections Staff:*Email* Telephone Number*Date* MM slash DD slash YYYY Captcha