Company:

Phone Number:

Fax Number:

Email:

Address:

City:

State / Province :
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Business Structure:
Select One Proprietorship Partnership Corporation
Business Type:
Select One Paint Contractor Designer General Contractor Developer Other
Owner / Principal:

Address:

Owner / Principal:

Address:

Owner / Principal:

Address:

Are you a subsidiary or division of another company? Yes No

Sales Use Tax
I HEREBY CERTIFY that we hold sales tax
Exemption #:

issued pursuant to Sales Tax Law.
That we are in the business of selling:

I FUTHER CERTIFY that I am authorized by the above listed organization(s) to submit this form.
Your Name:


Banking Info:
Bank:

Branch:

Officer:

Address:

Type of Account Requested:
Credit COD
Credit Line Requested:
(if more than $2500 bank statements required)
$
Trade References:
(Wallcovering sources preferred)
Ref 1
Name:

Address:

Phone Number:

Ref 2
Name:

Address:


Phone Number:

Ref 3
Name:

Address:


Phone Number:

How long in business under this name?
Years
Have you ever filed bankruptcy?
Yes Business
Yes Business
No

I agree to the terms of this application.
[View Terms]
I Agree