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Get J Valentine New Account Application Form

NEW ACCOUNT APPLICATION FORM Business Name Contact Name Tel D. B. A. if Applicable Sole Proprietorship Toll free 1. 877. 236. 9894 Fax 562. 531. 2478 Website www. jvalentinecatalog. com Email info jvalentinecatalog. com BUSINESS CONTACT INFORMATION Seller s Permit No Title Fax Email Years In Business Terms Requesting Partnership Corporation Other BUSINESS AND CREDIT INFORMATION Billing Address City State Shipping Address Please Indicate Store Type website customers must provide URL address below Retail Store Website Road/Club Other specify Current Suppliers Credit Card Type Credit Card Number Visa MasterCard Credit Card Billing Address BUSINESS/TRADE REFERENCES Company Name Address Phone Terms Exp. Date Zip Code Home Parties Authorization No Zip WITHIN THE INTIMATE APPAREL INDUSTRY AGREEMENT By signing you agree to all terms and conditions of J. Valentine Inc. By submitting this application you authorize J. Valentine Inc. to make inquiries into the business/trade references that you have supplied. All fields must be completed missing information may result in the cancellation of your request. NEW ACCOUNT APPLICATION FORM Business Name Contact Name Tel D. B. A. if Applicable Sole Proprietorship Toll free 1. 877. 236. 9894 Fax 562. 531. 2478 Website www. jvalentinecatalog. com Email info jvalentinecatalog. com BUSINESS CONTACT INFORMATION Seller s Permit No Title Fax Email Years In Business Terms Requesting Partnership Corporation Other BUSINESS AND CREDIT INFORMATION Billing Address City State Shipping Address Please Indicate Store Type website customers must provide URL address below Retail Store Website Road/Club Other specify Current Suppliers Credit Card Type Credit Card Number Visa MasterCard Credit Card Billing Address BUSINESS/TRADE REFERENCES Company Name Address Phone Terms Exp* Date Zip Code Home Parties Authorization No Zip WITHIN THE INTIMATE APPAREL INDUSTRY AGREEMENT By signing you agree to all terms and conditions of J* Valentine Inc* By submitting this application you authorize J* Valentine Inc* to make inquiries into the business/trade references that you have supplied* All fields must be completed missing information may result in the cancellation of your request. A copy of your business license is required without exception* REMINDER Please note that J* Valentine Inc* is for RETAIL TRADE BUSINESS ONLY. Failure to fax your Business Certificate and/or Tax ID will result in your request being denied without exception* Please allow 5 working days for review process J* Valentine Inc* reserves the right to decline any new customer application without cause. Please note that by submitting this form in no way guarantees approval* J* Valentine Inc* reserves the right to deny any application without reason given* / / Signature Date. NEW ACCOUNT APPLICATION FORM Business Name Contact Name Tel D. B. A. if Applicable Sole Proprietorship Toll free 1. 877. 236. 9894 Fax 562. 531. 2478 Website www. jvalentinecatalog. com Email info jvalentinecatalog..

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