Click here to download our credit application or fill in the info below Company Info Company Name   Mailing Address   City  State  Zip  Shipping Address   City  State  Zip  Phone  Fax  email  Choose one Sole Proprietor Partnership Corporation : :     Number of Employees  Federal Tax ID  Years at Present Location  Limit Requested $   Ave. Purchases $   Year Established      Contacts     Accounts Payable    Phone  Office Manager      Phone  Authorized Buyers:     1. 2.   3.       Purchase Order Requirements  Purchase Order Required :   yes? no?  Special Instructions  : Special Delivery Instructions   :        Responsible Parties or Officers  Name Title Home Address       Misc Questions Is your company non-profit or tax exempt?   yes? no?  |   Please list tax exempt #        Will his account be used for the purchase of any resale merchandise?   yes? no?  |   Please list resale #

Terms: Amount due on or before the 10th.
Past due after the 15th.
All returns subject to a 15% restocking fee.
No returns after 30 days.
All returned checks are subject to a $25.00 processing fee.

Please print out application and fax to Dorothy at 702-457-5858