ACCOUNT SETUP & CREDIT APPLICATION

ACCOUNT SETUP & CREDIT APPLICATION
Thank you for working with Diversified Labeling Solutions, Inc. Please complete the information below and we will contact you shortly with your account info.
ACCOUNT INFO
Company Name*
Billing Contact*
Company Phone Number*
Please enter a valid phone number.
Billing Contact Email*
example@example.com
Your Name*

First NameLast Name
Your Title*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Who should receive company updates from Diversified?

Same as aboveOther
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Are you a member of a distributor group? (If yes, please provide name)
CREDIT INFO
Please upload your resale or tax exemption certificate here.*

We need a copy process your credit application.
Cancelof
Duns #*
Years in Business*
Name of Bank*
Bank Contact*
Bank Phone Number*
Please enter a valid phone number.
Account Number*
Bank Address*

Street Address

Street Address Line 2

CityState

Zip Code
REFERENCES

Please supply three (3) trade references with addresses, phone and email addresses.

Signature and title of company officer authorizing your bank to supply us with pertinent information.
Signature*

Clear
Title
Please verify that you are human*
Should be Empty: