New Wholesale Account Application

Business Contact Information:
Company Name:*
Point of Contact:*

First NameLast Name
Tax Resale Number:
Federal Tax ID:
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Registered Company Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Business Commenced:*

MonthDayYear
Date
Business Type:*

Sole ProprietorshipPartnershipCoorporationOther
Company Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Type of Account:
Company Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Type of Account:
Attach resale certificate here.

Cancelof
By submitting to this application, you agree to the following:

1. I accept all terms and conditions set out by Boxwood Needlepoint.

2. I agree to be responsible for all purchase orders submitted.

3. I understand payment is due at time of shipment and will pay invoices promptly.
Signature
Should be Empty: