Business Name
(DBA / AKA)  
Office use only
Account
Date
Employee

Delivery Information

Contact Person
Billing Address
City, State, ZIP
E-mail
Phone (1)
Phone (2)
Fax

Billing Information

Contact Person
Billing Address
City, State, ZIP
E-mail
Phone (1)
Phone (2)
Fax

Business Background

Owner Phone
Manager Phone
Employee
Employee
Employee
Employee
Employee
Employee
Type of Business (Formalwear, Bridal Shop, Florist, etc
Years in Business
Main Competitor

Other Locations

Please Include any other stores that are owned by the same company
Address City State Zip Phone

Store House

Through
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Through
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Wholesale Activity

What other formal wear wholesalers Do you have Active accounts with?
Wholesaler Account Age Units rented Per Year

Credit Card Payments

Visa Mastercard Discover Amex
Name on Card Expiration
Business Name    
Credit cardbilling address CVV2 Security code
 
City, State, ZIP
All accounts paying exclusively by credit card, at the time of order, will receive an additional 5% discount.

Trade Creditors

Company Address Account# Phone Fax Sales Rep name City State Zip
Company Address Account# Phone Fax Sales Rep name City State Zip
Company Address Account# Phone Fax Sales Rep name City State Zip
 


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