Wholesale Account Application

Business Details
What type of business do you have or are opening?

Bar/RestaurantCoffee Shop/CafeDonuts/Dessert ShopFood Service/DistributorIce Cream/Frozen Yogurt
BUSINESS STRUCTURE:
Date Started:

MonthDayYear
Date
FEDERAL TAX ID# or SOCIAL SECURITY NUMBER:
RESALE NUMBER:
BUSINESS LICENSE NUMBER:
UPLOAD FILES - PDF, JPG (example: Business License, Sellers Permit, Tax ID, etc.)

Cancelof
Purchasing Point of Contact Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Accounts Payable Contact Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Email:
example@example.com

Trade and Bank Information

OPTIONAL SECTION
TRADE REFERENCE: NAMES
Contact:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com
Bank Name:
Bank Officer:
ACCOUNT TYPE / ACCOUNT NUMBER:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
By E-signing below, I hereby certify that the above information provided is correct and I authorize the release of credit information to 1Top Tword Corp DBA One Top. by our bank and trade references. 1Top Tword Corp DBA One Top. will expect prompt payment within the credit limit and term granted. Failure to comply with credit terms will be grounds for immediate termination of credit privileges. The undersigned agrees to comply with credit terms extended with full knowledge that any cost incurred by 1Top Tword Corp DBA One Top. to secure will be the responsibility of the undersigned. These may include, but are not limited to, collection agency fees and legal expenses. All accounts beyond terms are subject to 1.5% monthly service charge (18% per annum).
Full Name

First NameLast Name
E-Signature

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Date Signed

MonthDayYear
Date
Should be Empty:

Business Details