W H O L E S A L E C R E D I T A P P R O VA L F O R M To qualify for Net 15 or Net 30 credit terms, please fill out this form and email it to greetings@xistis.com ] . If you have any additional questions or information, please do not hesitate to call our studio at 208 . 267 . 2187. Thank you for your business and support. COMPANY PROFILE Client Name
Representative
Business Name
DBA
Street Address
Business Type:
Corp.
City
State
State of Incorporation
Zip
Tax ID - EIN Number:
Phone
Fax
Proprietorship
Partnership
STORE OWNERSHIP Name
Address
Phone
City
Social Security:
State
Zip
BANK REFERENCE Name of Bank Phone Street Address City
State
Zip
TRADE REFERENCES Company Contact
Address Phone
City
Company Contact
State
Zip
State
Zip
Address Phone
City
CREDIT CARD AUTHORIZATION Card Type
Visa
Mastercard
American Express
Card Number
Discover
Other
Expiration Date:
Name on Card Billing Address
City
State
Zip
The undersigned authorizes the above banks to release credit information to Capael Studios - SCS LLC. Signature
Account No.:
Date