Online Ordering Log-in
Customer Number
Password
Wholesale Account Application Form
Account type desired
Open Account
Credit Limit
or COD/Company check
Company Name
Phone Fax
Billing Address
City,State,Zip
Shipping Address
City,State,Zip
Business Location
Commercial Bldg.
Internet based
Home Residence
Is this a Corporation?
Yes
No
At this location?
years
In business?
years
IRS ID Number
Resale #
Previous Address
Other Branch Addresses
Name of Manager
Name of Buyer
Name and Title of Owners/Partners/Officers
Bank Name
Account Number
Bank Address
City,State,Zip
Bank Phone
Do you pledge to borrow on your accounts receivable?
Yes
No
BUSINESS REFERENCES: MUST BE COMPLETE!
Name
Phone
Address
City State Zip
Name
Phone
Address
City State Zip
Name
Phone
Address
City State Zip
Name
Phone
Address
City State Zip
I/we authorize CSI to investigate bank/business references listed for the purpose of obtaining an account with CSI and certify the information given to be current and correct. Upon submitting this application, I/we personally guarantee payment of all invoices in full and in accordance with the terms of sale set forth by Competition Specialties, Inc. (CSI). Copies of CSI terms and policies are available upon request. I/we fully understand this to be a binding obligation, which in the event the CSI brings legal action to enforce payment, I/we promise to pay past due service charges/collection agency charges/attorney fees and court costs.
Owner/Partner/Officer Name
*Required
Check if you agree to above statement
Yes -
No -
E-mail Address
© Copyright Competition Specialties Inc. 2009
2402 West Valley Highway North Auburn Washington 98001 253-833-6211
