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Wholesale Gallery Account Application

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Mail to:
The Art of Randy Green
103 Evergreen Place
Cross Junction, VA 22625

Company Name : __________________________________________________________________________________________
Phone : ______________________________________________   FAX : __________________________________________
Email : _________________________________________________________________________________________________
Web Address :  http://www.__________________________________________________________________________________
Shipping Address : _________________________________________________________________________________________
Years in Business : _____
Check One:  Proprietorship ____ Partnership _____ Corporation ____ LLC ____ Other ______
Corporate FED ID# / Partnership # / LLC #  : ______________________________________________________________
Proprietor's SSN or EIN # : _________________________________________________________________________________
Resale # (Please attach copy of resale certificate) : ____________________________________________________________

Owners / Principals

Name : ____________________________________________ Position : _________________________________________
Address : __________________________________________________________________________________________
Name : ____________________________________________ Position : _________________________________________
Address : _______________________________________________________________________________________________
Name of Person who handles Payment & Billing : ___________________________________ Position : _____________________
Email : ______________________________________________________ Phone : ________________________________

Trade References

Name Address Phone
1.______________________________________________________________________________________________________
2.______________________________________________________________________________________________________
3.______________________________________________________________________________________________________
Bank Name : ______________________________ Address : ___________________________________________________
Account # : _______________________________ Phone : ______________________________ FAX : __________________

I AUTHORIZE THE BANK LISTED ON THIS APPLICATION TO PROVIDE INFORMATION ON MY ACCOUNT TO THE ART OF RANDY GREEN.

 

Authorized Signature : ______________________________________________________________________________________

In making this application for credit, I/We hereby agree that all amounts are payable on or before the net due date as shown on each invoice, and if not paid on or before said date, are then delinquent.  Delinquent accounts are subject to a late fee of 1.5% per month (18% Annually) or to collection proceedings at The Art of Randy Greens' option.
If credit is granted, I/We agree to the above terms and the undersigned is/are responsible for Payment of the account.  If I/We fail to pay The Art of Randy Green for purchases made by Me/Us on account when due, I/We agree to pay all costs of collection and reasonable attorneys' fees and costs incurred by The Art of Randy Green whether or not suit is filed hereon.  Any failure of The Art of Randy Green to avail itself of any of the remedies herein shall not be considered a waiver of its rights to avail itself of such remedies at a later date.

This agreement is entered into in Cross Junction, Virginia, U.S.A.

Signature: _____________________________________ Title: ___________________________Date: ________________

Please attach a copy of your business license and brief business profile.

 

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