WHOLESALE CREDIT APPLICATION
| R&Z/The
Quiltworks 1055 American Blvd. E Minneapolis, MN 55420-1460 (952) 854-1460 • Fax (952) 854-7254 |
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| Business Name | Accts. Payable Name | |||
| Mailing Address | Shipping Address | |||
| City, State, Zip | City/State/Zip | |||
| Bus. Phone Fax | Payable Phone # | |||
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Owner/Officer
Information • Name/Address/Home Phone (must be completed)
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| Owner's Name | Owner's Name | |||
| Home Address | Home Address | |||
| City, State, Zip | City/State/Zip | |||
| Home Phone | Home Phone | |||
| __Sole Owner __Partnership __Corporation | Buyer's Name | |||
| Names of Authorized Acct. Users | ||||
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Company
Information
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| Sales Tax ID No./EIN No. | Social Security No. | |||
| Description of Business | How Long in Business Annual Sales | |||
| Account
Requested: __C.O.D. (Co. Check)
__Cash __Net 30 Credit __Credit Card: Card no. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. __ __ /__ __ |
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| Monthly Line of credit desired | Have you had an account with us before? | |||
| Merchandise you plan to purchase: __Fabrics __Supplies __Crafts __Industrial __Other | ||||
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Trade
References List 3 or more commercial firms from which you buy on credit (required
for Net 30)
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| Name | Name | |||
| Address | Address | |||
| City, State, Zip | City, State, Zip | |||
| Phone Fax | Phone Fax | |||
| Acct. Number | Acct. Number | |||
| Name | Name | |||
| Address | Address | |||
| City, State, Zip | City, State, Zip | |||
| Phone Fax | Phone Fax | |||
| Acct. Number | Acct. Number | |||
| To
enable us to give you the highest possible monthly
line of credit and to expedite processing, please
supply us with a personal net worth statement(s)
if your business is a sole operating proprietorship
or partnership. If your business is incorporated,
we will need the most recent corporate balance
sheet. The undersigned agrees that upon approval
of this application for credit, any charges
to his/her account are due and payable under
the terms of Rubenstein & Ziff, 1055 American
Blvd. E, Minneapolis, MN 55420. The undersigned
also agrees to pay all actual costs of collection,
including court costs and reasonable attorney
fees. Signed______________________________________ Title__________________________ Date___________ I certify the information is true and correct. I authorize Rubenstein & Ziff, Inc. to contact my references to establish credit terms. |
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Bank
Reference Authorization (must be completed)
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| For
the purpose of obtaining merchandise on credit, I authorize: Bank Name___________________ Banker_____________ Bank Address_______________________________ Phone #_______________________________ City_________________________ State_________ Zip______ to release information on my financial condition. PERSON ON BANK SIGNATURE CARD SIGNS BELOW. |
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| Signed______________________________________ Acct. No._______________________________________ Position or Title/Business Name___________________________________________ Date_________________ |
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