Before filling out our credit application, please read over our terms of sale.
If you would prefer to print out the Credit Application Form and mail it in, please click here for a printable copy in PDF format. You must have Adobe Acrobat Reader to be able to read & print the form.
City:
State:
Zip:
Shipping Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Accounts Payable Contact:
The following information must be completed in full. All information will be held in strict confidence.
Business Type:
Corporation Partnership
Proprietorship Individual
Incorporated within the last 12 months
Ownership
Name (President):
Address:
City:
State:
Zip:
Name (Secretary):
Address:
City:
State:
Zip:
Name (Treasurer):
Address:
City:
State:
Zip:
Credit Information
Bank Name:
Bank Officer's Name:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Account Number:
Federal ID#:
Credit References (No Utilities, phone, cable companies, please.)
Credit Reference #1
Company Name:
Account Number:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Credit Reference #2
Company Name:
Account Number:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Credit Reference #3
Company Name:
Account Number:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Other References
Other Reference #1
Company Name:
Account Number:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Other Reference #2
Company Name:
Account Number:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Your Questions or Comments:
Terms are NET 30 days. Extending payments beyond the 30 day period may incur an additional charge of 1 1/2% per month. The terms of sale have been fully explained to me by my Account Executive and I agree and accept stated terms.
We will review your application and get back with you regarding your account within 5 business days. If your wholesale account is approved, we will send you an email with your password to use our wholesale online catalog.
