Boutique Wholesale Credit Application
Business Information
Business Name
Business Address
City
State
Zip Code
Business Phone
Business Email
Type of Business
Tax ID/EIN
Owner/Principal Information
Owner/Principal Name
Title
Phone
Email
Address
Bank References
Bank Name
Account Number
Bank Contact
Bank Phone
Trade References
Trade Reference 1 Name
Phone
Account Number
Trade Reference 2 Name
Phone
Account Number
Credit Request Details
Credit Amount Requested
Requested Terms
Additional Notes
Notes
Agreement & Authorization
Authorized Name
Title
Date