Application Instructions:
  1. Fill in the information below.
  2. When complete, click “Submit” which will register your account in our system.
  3. Print and fax your signed form to (785) 368-7504 or email your signed form (and sales tax exempt form, if applicable) to business@safetstep.com.
USER INFORMATION * Required Fields
BILLING INFORMATION

* Please select a payment method


$
Please email/fax a copy of your Sales Tax Exempt form along with this application. You will receive notification via email once tax exempt status is approved and account is activated. Upon notification, orders can be placed.
BILLING ADDRESS


After you click, “Submit”, your application will be printable. Please print, sign and fax your signed form to (785) 368-7504 or email your signed form (and sales tax exempt form, if applicable) to business@safetstep.com.



TERMS AND CONDITIONS
AUTHORIZATION TO CHARGE AND PROMISE TO PAY
(LINE OF CREDIT)

By submitting this application on behalf of your business, the applicant above (“Applicant) is applying for a Commercial Credit Account (“Account”) with Payless ShoeSource, Inc. (“Payless”) subject to these Terms and Conditions (“Agreement”). Applicant represents that it is a valid business entity, all purchases made on this Account, if approved, will be for business purposes and not for personal, family or household use. Applicant further represents that the person submitting this application is an authorized representative of the business with authority to enter into contractual agreements to obtain credit.

1.        AUTHORIZATION. Applicant authorizes and requests each bank and trade reference to advise Payless on its credit history and record and authorizes Payless and its affiliates to obtain credit reports in connection with the opening, monitoring, renewal, and extension of this and other accounts with Applicant’s company. Applicant further authorizes Payless, to share the information received from this investigation with its parent, subsidiaries, and affiliates. Applicant agrees to promptly notify Payless, of changes in any of the above information provided in this application in writing. Until Payless is notified that your address has changed, Payless will continue to send invoices and other notices to the last address we maintained on your Account.

2.        PROMISE TO PAY. Applicant agrees to pay Payless for all purchases made in accordance with these terms which shall supersede any of Applicant’s purchase order terms to the contrary. Payless, or its affiliates will transmit or send to Applicant an invoice for any purchases made pursuant to this Account. Payment is due 30 days after the date of the invoice. Interest may be assessed at the lesser of (a) 1 ½% per month (18% annually) or (b) the maximum allowable by state law on all balances not paid within these terms. Payless, and its affiliates reserve the right in its sole discretion to cancel applicant’s right to charge pursuant to this Account at any time by giving written notice to the applicant at its billing address. Applicant will pay all costs and expenses of collection of delinquent amounts, including attorney fees.

3.        PERSONALLY IDENTIFIABLE INFORMATION. Applicant represents and warrants that it will not transmit or disclose any Personally Identifiable Information (“PII”) to Payless under any SafeTStep business program for any purpose, including facilitating Applicant’s payroll deduction. The parties do not intend or desire to exchange PII under this Agreement in any form, encrypted or unencrypted. Applicant is responsible for taking such measures as are necessary to prevent the transmission or disclosure of PII to Payless. For purposes of this Agreement, PII means the first and last name of any Applicant employee, or the first initial and last name of any such employee and any of the following, including but not limited to, such employee’s social security number, government identification number, date of birth, credit card number, financial account information, health information or any other information regarding such individual which is subject to heightened legal obligations under any applicable data security law.

4.        INDEMNIFICATION. Applicant shall indemnify, defend and hold Payless harmless from any third party claims, damages or expenses incurred by Payless as a result of loss, unauthorized disclosure or unauthorized use of any PII transmitted , or disclosed under this Agreement.

5.        PASSWORDS. Payless will provide Applicant with an initial user ID and password for purchases under an Account. Applicant is solely responsible for the ongoing confidentiality, management, security and safety of the user ID and password. Applicant acknowledges and agrees that it is responsible for any unauthorized activities, charges and/or liabilities made on or through Applicant’s user ID and password.

6.        TERMINATION. Applicant may at any time terminate its Account by written notice to Payless. Payless may, at any time (a) terminate Applicant’s Account; (b) terminate Applicant’s right to make future purchases. Upon any termination of this Agreement Applicant will continue to be obligated to pay all amounts owing under this Account.

7.        LIMITATION OF LIABILITY. PAYLESS SHALL USE REASONABLE EFFORTS TO PROTECT INFORMATION SUBMITTED BY YOU IN CONNECTION WITH APPLYING FOR AN ACCOUNT AND UNDER ANY SAFETSTEP BUSINESS PROGRAM, BUT YOU AGREE THAT YOUR SUBMISSION OF SUCH INFORMATION IS AT YOUR SOLE RISK, AND PAYLESS HEREBY DISCLAIMS ANY AND ALL LIABILITY TO YOU FOR ANY LOSS OR LIABILITY RELATING TO SUCH INFORMATION IN ANY WAY. IN NO EVENT SHALL PAYLESS BE LIABLE FOR ANY INDIRECT, SPECIAL, OR CONSEQUENTIAL DAMAGES OF ANY KIND OR NATURE WHATSOEVER, INCLUDING WITHOUT LIMITATION, LOSS OF PROFITS OR OTHER ECONOMIC LOSS, EVEN IF APPLICANT HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

8.        CONSENT TO JURISDICTION. Any legal action or proceeding with respect to this Account shall be brought in the courts of the State of Kansas or the United States for the District of Kansas, and by submission of this Application, Applicant hereto consents to the exclusive jurisdiction of those courts. Applicant irrevocably waives any objection, including any objection to the laying of venue or based upon the grounds of forum non conveniens, which it may now or hereafter have to the bringing of any action or proceeding in such jurisdiction in respect to this Account. Process may be made by certified mail or by any other means permitted by Kansas state law. Notices provided to Payless shall be sent to Payless ShoeSource, Inc., Attn.: Vice President Merchandise Planning, 3231 SE Sixth Avenue, Topeka, KS 66607-2207 with a copy mailed to the same address and addressed to the attention of the General Counsel for Payless. Notices to Applicant shall be to last address maintained on your Account.

9.        CHANGES IN TERMS AND CONDITIONS. Payless reserves the right at any time to modify these Terms and Conditions and to impose new or additional terms or conditions on Applicant’s Account. Such modifications and additional terms and conditions will be effective immediately and incorporated into these Terms and Conditions. Your continued use of your Account will be deemed acceptance thereof.

Applicant consents to Payless and any other owner or servicer of the Account (Collectively, “Servicer”) contacting Applicant about the Account, including using any contact information or cell phone numbers provided, and Applicant consents to the use of any automatic telephone dialing system and/or an artificial or prerecorded voice when calling, even if Applicant is charged for the call under Applicant’s phone plan. Applicant authorizes Servicer and its assignees to obtain information about Applicant for purposes of updates, renewals or extension of credit granted as a result of this Application, or in receiving or collecting monies owed on the Account. Applicant also understands that there is no binding contract between Payless and Applicant until the application is approved.
TERMS AND CONDITIONS
AUTHORIZATION TO CHARGE AND PROMISE TO PAY
(CREDIT CARD)

The applicant above (“Applicant) is authorizing Payless ShoeSource, Inc. (“Payless”) to charge the credit card provided for any purchases and agrees to these Terms and Conditions (“Agreement”). Applicant represents that it is a valid business entity, all purchases made on this Account will be for business purposes and not for personal, family or household use. Applicant further represents that the person submitting this application is an authorized representative of the business with authority to enter into contractual agreements.

1.        NOTIFICATION. Applicant agrees to promptly notify Payless, of changes in any of the above information provided in this application in writing. Until Payless is notified that your address has changed, Payless will continue to send notices to the last address we maintained on your Account.

2.        PERSONALLY IDENTIFIABLE INFORMATION. Applicant represents and warrants that it will not transmit or disclose any Personally Identifiable Information (“PII”) to Payless under any SafeTStep business program for any purpose, including facilitating Applicant’s payroll deduction. The parties do not intend or desire to exchange PII under this Agreement in any form, encrypted or unencrypted. Applicant is responsible for taking such measures as are necessary to prevent the transmission or disclosure of PII to Payless. For purposes of this Agreement, PII means the first and last name of any Applicant employee, or the first initial and last name of any such employee and any of the following, including but not limited to, such employee’s social security number, government identification number, date of birth, credit card number, financial account information, health information or any other information regarding such individual which is subject to heightened legal obligations under any applicable data security law.

3.        INDEMNIFICATION. Applicant shall indemnify, defend and hold Payless harmless from any third party claims, damages or expenses incurred by Payless as a result of loss, unauthorized disclosure or unauthorized use of any PII transmitted , or disclosed under this Agreement.

4.        PASSWORDS. Payless will provide Applicant with an initial user ID and password for purchases under an Account. Applicant is solely responsible for the ongoing confidentiality, management, security and safety of the user ID and password. Applicant acknowledges and agrees that it is responsible for any unauthorized activities, charges and/or liabilities made on or through Applicant’s user ID and password.

5.        TERMINATION. Payless may at any time terminate Applicant’s right to make future purchases. Upon any termination of this Agreement Applicant will continue to be obligated to pay all amounts owing.

6.        LIMITATION OF LIABILITY. PAYLESS SHALL USE REASONABLE EFFORTS TO PROTECT INFORMATION SUBMITTED BY YOU UNDER ANY SAFETSTEP BUSINESS PROGRAM, BUT YOU AGREE THAT YOUR SUBMISSION OF SUCH INFORMATION IS AT YOUR SOLE RISK, AND PAYLESS HEREBY DISCLAIMS ANY AND ALL LIABILITY TO YOU FOR ANY LOSS OR LIABILITY RELATING TO SUCH INFORMATION IN ANY WAY. IN NO EVENT SHALL PAYLESS BE LIABLE FOR ANY INDIRECT, SPECIAL, OR CONSEQUENTIAL DAMAGES OF ANY KIND OR NATURE WHATSOEVER, INCLUDING WITHOUT LIMITATION, LOSS OF PROFITS OR OTHER ECONOMIC LOSS, EVEN IF APPLICANT HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

7.        CONSENT TO JURISDICTION. Any legal action or proceeding shall be brought in the courts of the State of Kansas or the United States for the District of Kansas, and by submission of this Application, Applicant hereto consents to the exclusive jurisdiction of those courts. Applicant irrevocably waives any objection, including any objection to the laying of venue or based upon the grounds of forum non conveniens, which it may now or hereafter have to the bringing of any action or proceeding in such jurisdiction. Process may be made by certified mail or by any other means permitted by Kansas state law. Notices provided to Payless shall be sent to Payless ShoeSource, Inc., Attn.: Vice President Merchandise Planning, 3231 SE Sixth Avenue, Topeka, KS 66607-2207 with a copy mailed to the same address and addressed to the attention of the General Counsel for Payless. Notices to Applicant shall be to last address maintained on file.

8.        CHANGES IN TERMS AND CONDITIONS. Payless reserves the right at any time to modify these Terms and Conditions and to impose new or additional terms or conditions. Such modifications and additional terms and conditions will be effective immediately and incorporated into these Terms and Conditions. Continued use of the SafeTStep business portal will be deemed acceptance thereof.

Applicant consents to Payless and any other owner or servicer of Payless (Collectively, “Servicer”) contacting Applicant, including using any contact information or cell phone numbers provided, and Applicant consents to the use of any automatic telephone dialing system and/or an artificial or prerecorded voice when calling, even if Applicant is charged for the call under Applicant’s phone plan. Applicant also understands that there is no binding contract between Payless and Applicant until this authorization is received and accepted by Payless.



APPLICANT



Signature of Authorized Representative



Name (Please Print)



Title



Company



Date