SPLITS59 New Account Profile

NEW ACCOUNT PROFILE
Account Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Legal Billing Name
DBA
Ship To Address
*If address is not a business extra charges will apply for a signature upon delivery*
Tel#
Email
example@example.com
Website
Name of Owner/Principal
Title
Buyer Name
Email
example@example.com
Phone
Format: (000) 000-0000.
Name of Accounts Payable
Phone
Format: (000) 000-0000.
Fax
Type of Business
Store Open: Yes / No Opening Date:

Comparable lines you are selling in your store now?
Store Open?
Opening Date
Years In Business
Size Of Store (sq ft)
Store/Studio Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Comparable Lines You Are Selling Now? List 6.
Will you be issuing your own PO numbers and hard copies of orders?
Do you have a FedEx, UPS, or DHL number you would like to use? If so, please provide number?
How Did You Hear About Splits59?
What stores in your area do you feel could be considered competition?
Checked distance to other Splits59 accounts How many miles? blanks(Splits59 Corporate Use Only)
Please Attach Images Of Your Store (Inside And Outside) As Well As Financial Information For Credit Purposes.

Cancelof
Should be Empty:

NEW ACCOUNT PROFILE