Retailer Credit Application

Retailer / Credit Application

Please fill out the information below to submit your application. All fields are required.

Type Of Business (please check one or more):

Retail

Web

Commercial

Designer

Corporate Name:

Phone

Address:

City:

State:

Zip Code:

Fax Number:

Federel ID#:

State Incorporated:

Years Incorporated:

Website:

Buyer Contact:

Phone Number:

Fax Number:

Email:

Accounts Payable Contact:

Phone Number:

Fax Number:

Email:

Billing Address:

City:

Zip Code:

State:

Payment Terms Requested (please check one):

Credit Card (Visa/MC Only)

Prepay

Net 30 Terms