Acupressure.com Wholesale

Wholesale Account Application Form

Please fill out the form below to become eligible to buy products at a discount.

*Denotes required field

*Company:

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip Code:

*Country:

*Phone:

your email will be used as your login name

*Email:

*Re-enter Email:

A valid password is 7-15 characters long and can contain upper or lower letters and numbers only.

*Password:

*Re-enter Password:

Please select a secret question and answer which will be used to recover your password in case you forget it.

*Secret Question:

*Secret Answer:

*Resale#:

You must provide your State Resale Tax ID number before we can ship goods to you at wholesale prices

Website:

Description of
your business:

Legal Owner:

Credit Application (optional)
If you use a purchase order or would like to pay by check, please fill out the form below.
Applying for credit

Credit Amount
Requested:

Trade References

Company Name:

Legal Owners(s):

Address:

City:

State/Province:

Country: Postal/Zip Code:

Phone:

Fax: Email:

Doing Business Since:

Last Order Date: Average Annual Purchases:

Company Name:

Legal Owners(s):

Address:

City:

State/Province:

Country: Postal/Zip Code:

Phone:

Fax: Email:

Doing Business Since:

Last Order Date: Average Annual Purchases:

Bank Reference

Bank Name:

Account Manager/Contact:

Bank Address:

City:

Bank State/Province:

Country: Postal/Zip Code:

Bank Account #:

Phone:

I/We hereby authorize Acupressure.com to make enquiries necessary in order to grant credit approval.

By filling out this Wholesale Application form you authorize Acupressure.com to make any inquiries necessary to process this Credit Application and verify that all information provided above is correct.

			Wholesale Account Application Form Please fill out the form below to become eligible to buy products at a discount. Denotes required field Company: First Name: Last Name: Address: City: State: Zip Code: Country: Phone: your email will be used as your login name Email: Re-enter Email: A valid password is 7-15 characters long and can contain upper or lower letters and numbers only. Password: Re-enter Password: Please select a secret question and answer which will be used to recover your password in case you forget it. Secret Question: Secret Answer: Resale#: You must* provide your State Resale Tax ID number before we can ship goods to you at wholesale prices Website: Description of your business: Legal Owner: Credit Application (optional) If you use a purchase order or would like to pay by check, please fill out the form below. Applying for credit Credit Amount Requested: Trade References Company Name: Legal Owners(s): Address: City: State/Province: Country: Postal/Zip Code: Phone: Fax: Email: Doing Business Since: Last Order Date: Average Annual Purchases: Company Name: Legal Owners(s): Address: City: State/Province: Country: Postal/Zip Code: Phone: Fax: Email: Doing Business Since: Last Order Date: Average Annual Purchases: Bank Reference Bank Name: Account Manager/Contact: Bank Address: City: Bank State/Province: Country: Postal/Zip Code: Bank Account #: Phone: I/We hereby authorize Acupressure.com to make enquiries necessary in order to grant credit approval. By filling out this Wholesale Application form you authorize Acupressure.com to make any inquiries necessary to process this Credit Application and verify that all information provided above is correct.

		© Copyright 2004-2012 Michael Reed Gach, All Rights Reserved. info@acupressure.com