Vendor form

Retailer form

Required *

First Name

Last Name

E-mail address

Company name

Trade Names, website addresses, catalog names, TV channel names (please list all)

Corporate Address and owner/CEO/Primary Contact Info:

Phone and Fax Numbers:

Accounts Payable Contact Name, Email and Phone:

Purchasing Contact Name, Email and Phone:

Years in business

Dunn and Bradstreet and/or LYON number if available

Federal Tax ID

Sales Tax Registration State and License Number:

2015 Gross Sales

2016 Gross Sales

2017 Gross Sales

2018 Gross Sales

Bank References. Name(s) of Bank(s), address, phone number, fax and contact name OR if you will be a credit-card-with-order-customer, call us with your credit card number, expiration date and security code

Trade Reference No.1 ( unless you will be paying by credit card )

Trade Reference No.2 ( unless you will be paying by credit card )

Trade Reference No.3 ( unless you will be paying by credit card )

Courier service you use

Your UPS/FedEx account number

LTL Carrier Name, contact information and account number:

Typed Signature

Captcha

lighting

Lake Shore

Wooden

Vendor form

Retailer form