This is an application for consideration to become an authorized Retailer of Benjamin Moore & Co. ("BM"). I understand that the submittal of this Application is an initial step in the process towards qualification as an authorized Retailer of BM products ("Authorized BM Retailer") and does not obligate BM or the applicant to either grant or accept the opportunity to become an Authorized BM Retailer. I understand that this Application does not constitute an offer to approve me or my associated entity as an Authorized BM Retailer, that this information is being provided to BM solely for the purpose of evaluating my personal, professional and financial qualifications, and that the information provided by me will be relied upon by BM as a material factor in considering my application to become an Authorized BM Retailer. BM's acceptance or approval of this Application shall not be considered as an offer or grant of an Authorized BM Retailership. I understand that becoming an Authorized BM Retailer is at the sole and absolute discretion of BM. I hereby authorize BM to obtain a credit report, perform a background check or any other investigative consumer report and to contact references and other sources, including former employers, in order to obtain personal information about me. I understand that any credit or investigative consumer report may contain information about my background, character, general reputation, mode of living, credit worthiness, ability and job performance. I understand and acknowledge that, as a condition of being considered to become an Authorized BM Retailer, my spouse and I must submit to a credit history check to be performed by a credit reporting agency of BM's choice. I understand that the credit reporting agency will make the results of the credit history check available to BM and that BM may use those results in determining whether I will be eligible to become an Authorized BM Retailer.
If requested by BM, I agree to supply statements from my professional advisors (i.e., banker, broker, accountant or attorney) verifying my financial qualifications, and I also agree to furnish copies of all Federal Income Tax Returns as filed on behalf of myself and my affiliates for the last five years. I hereby release BM, its affiliates, and their respective officers, agents and employees from any liability arising from the receipt or use of information obtained through these sources and from any investigation relating thereto. My authorization for release of information includes, but is not limited to, matters of opinion relating to my character, ability, reputation, criminal record and past performance. I hereby authorize all persons, schools, companies, corporations, past or present employers, credit bureaus, and law enforcement agencies to release such information without restriction or qualification to BM, its affiliates, and any of their officers, agents and employees. I voluntarily waive all recourse and fully release them from liability for complying with this authorization. This authorization/release shall apply to this as well as any failure request for an investigative consumer report. I authorize that a photocopy or facsimile of this release be considered as valid as the original.
I certify that neither I nor any of my funding sources, is or has ever been a terrorist or suspected terrorist, or a person or entity described in Section 1 of U.S. Executive Order 13224, issued September 23, 2001, as such persons and entities are further described at the Internet website www.ustreas.gov/offices/enforcement/ofac. I agree to comply with and/or to assist BM to the fullest extent possible in BM's efforts to comply with this and all other laws.
I certify that all information I supply to BM is true, accurate, and complete in all respects. I understand that providing false information or making omissions in my application can result in the denial of my application or the termination of any Authorized BM Retailership that I may receive from BM. I understand that BM is relying upon all of the information I supply as a material factor in considering whether or not to grant an Authorized BM Retailership, and I therefore agree to promptly notify BM of any changes in any of the information that I supply.
Each owner, partner, member and shareholder associated with the applicant's proposal to become an Authorized BM Retailer must complete an application.
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