Net 30 Credit Application | LidStyles Wholesale

Company Name:

Contact:

Billing Address:

City:

State:

Zip Code:

Shipping Address:

City:

State:

Zip Code:

Phone Number:

Fax Number:

Email:

Type of Business:

In Business Since:

Form of Business:

Corporation LLC Partnership Sole proprietor

Is a Purchase Order required?

Yes No

Name of individual with Authorization:

If it is to be a blanket PO, please list the number:

And date:

To whose attention should invoices be sent?

Is your work taxable?

Yes No

If not, please email a signed certificate to wholesale@lidstyles.com ; and please list your tax exempt or reseller's number:

If paying by credit card, please choose:

Visa Mastercard American Express

Credit Card Number:

Credit Card Expiration Date:

Bank References (please list names and addresses of local banks):

Trade References (please list names, addresses, phone numbers, and account numbers of 3 references. DO NOT include credit cards.):

Our terms are net 30 days. Accounts not paid in this time frame will be charged 1.5% interest rate per month and future orders will be on a C.O.D. basis until the account is current. Should collection or legal action be required to collect past dues, fees for such action will be added to your account. Please print first and last name:

Title:

Signed by:

Date: