Until credit can be approved, process my orders via COD Prepay Credit Card Hold orders until approved We do not wish to apply for open terms. Please process all orders as COD Prepay Credit Card Preferred invoice receipt method: * Include with shipment Mail at time of shipment Email at time of shipment Have you ordered from Artisans, Inc. before? * Yes No If Yes, When? Account # at that time If other information is required to process your orders, such as purchase order #’s, specific shipping instructions, etc. include those specifications. Are there multiple ship locations? * Yes No Artisans Sales Representative: BUSINESS INFORMATION LEGAL BUSINESS NAME & DBA IF APPLICABLE AUTHORIZED BUYING AGENT(S) TELEPHONE (###) ### #### ADDRESS (Billing) * Address 1 Address 2 City State/Province Zip/Postal Code Country ADDRESS (Shipping, If Different) Address 1 Address 2 City State/Province Zip/Postal Code Country FAX (###) ### #### FEDERAL ID# * STATE SALES TAX * Purchase not for resale. Tax will apply Purchase for Resale Tax Exempt Identification # TYPE OF BUSINESS (Resort, Boutique, etc) * YEAR BUSINESS ESTABLISHED * YEAR OF YOUR OWNERSHIP * ORGANIZATION (Corp, Sole Prop, etc) * ACCOUNTS PAYABLE CONTACT * First Name Last Name TELEPHONE * (###) ### #### E-Mail * OWNER NAME * First Name Last Name OWNER SS# * TELEPHONE * (###) ### #### BANK NAME * CONTACT NAME * TELEPHONE * (###) ### #### BUSINESS TRADE INFORMATION OR UPLOAD PREMADE CREDIT INFORMATION COMPANY CREDITOR #1 ACCOUNT# TYPE OF PRODUCTS PURCHASED TELEPHONE ADDRESS Address 1 Address 2 City State/Province Zip/Postal Code Country COMPANY CREDITOR #2 ACCOUNT# TYPE OF PRODUCTS PURCHASED TELEPHONE ADDRESS Address 1 Address 2 City State/Province Zip/Postal Code Country COMPANY CREDITOR #3 ACCOUNT# TYPE OF PRODUCTS PURCHASED TELEPHONE ADDRESS Address 1 Address 2 City State/Province Zip/Postal Code Country CREDIT REQUEST AGREEMENT I as the undersigned, give my authorization to ARTISANS, INC. to obtain a rating from the above named companies solely for the purpose of establishing open credit terms. I also understand that any information obtained will be kept strictly confidential by ARTISANS, INC. By submission of this application, we agree to payment terms of Net 30, and accept a service charge of 1½% per month on any overdue balance. Further, we agree to pay all reasonable attorney fees and costs if any overdue balance goes to collections. Name * First Name Last Name Signature * Please type full name Title * Date MM DD YYYY Thank you! Your application has been successfully submitted. Someone from our team will be in contact soon! Artisans Inc. Credit Application
