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Contact Information
 
Buyer First Name *
Buyer Last Name *
Company Name *
Address *
City *    State *    Zip *
Country *
Phone *    Alt. Phone
Fax
E-Mail *
AP Contact Name *
AP Contact E-Mail *
AP Contact Phone *
 

Other Store Information
 
Company Type * Corporation
Partnership
Individual (SSN):
Owner's Name *
Owner's Address *
City *    State *    Zip *
Type Of Business *
Date Started *
Federal Tax ID # *
State Reseller Permit #
 

Type Of Location *
 
Shopping Mall Strip Mall Free Standing Non-Profit
Other: Please Explain
 
Associations

Please check all that apply:
CBA NCGA
CMN Collectible
Other:
 
References

Please check all that apply:
1928 Jewelry Bliss Manufacturing Brownlow Publishing
Cathedral Art Metal Demdaco Dicksons
Giftcraft Inc. Virginia Candle Co. Ingram Content Group
Kurt S. Alder, Inc. Lighthouse Christian Products Midwest-CBK
Christian Art Gifts Ganz Precious Moments
Primitives by Kathy Yankee Candle Roman
Other Trade References:
Name    Phone    Fax
Name    Phone    Fax
Name    Phone    Fax
 
By checking here I certify that all of the above information is true *
By checking here I agree to the terms and conditions *
 


Terms and Conditions

All accounts are checked in advance, or credit card is needed until a credit application has been completed, reviewed and approved. If any indebtedness incurred pursuant to this request for credit is not paid in full when due, the undersigned agrees to pay all costs of collection, including a reasonable attorney's fee. Any unpaid balance shall bear interest at the rate of 1.8% per month or the maximum rate permitted by applicable law, until paid in full.

Accepting this agreement indicates your compliance of the terms and conditions as stated. In addition, you authorize Christian Brands®, Inc. to make any and all inquiries necessary to process the credit application.