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Haga's Party Options & More |
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| Business Name: | |||
| Business Address for Billing: | Address for Shipping: | ||
| City, State and Zip: | City, State and Zip: | ||
| Owner/Managers Name: | Contact Phone Number: | ||
| Accounts Payable Contact: | Contact Phone Number: | ||
| Business Fax Number: | |||
| Business Website: | |||
| Business Email Address: | |||
| How Long in Business: | D & B Number | ||
| EIN Number/Resale Number | |||
| Trade References | |||
| Name: | Address: | ||
| Account Number: | Phone Number: | ||
| Name: | Address: | ||
| Account Number: | Phone Number: | ||
| Name: | Address: | ||
| Account Number: | Phone Number: | ||
| Bank References: | |||
| Name of Bank: | Address: | ||
| Phone Number: | |||
| Name of Bank: | Address: | ||
| Phone Number: | |||
| Credit Line Requested: | Dollar Amount Limit per order? | ||
| Who is allowed to place orders? | Must your company PO form accompany order? | ||
| If you require your PO who is allowed to sign off on PO? | |||
| The undersigned authorizes inquiry as to the credit information. We further acknowledge that the credit privileges,
if granted, may be withdrawn at any time. __________________________________________________________ _____________________________ Signature Date __________________________________________________________ _____________________________ Printed Name Date |
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| For Company Use Only: |  ApprovedDenied |
Bank References |
Trade References |
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Haga's Party Options Party Store |