The following information must be completed in full. All information will be held in strict confidence.
Business Type:
Corporation Partnership
Proprietorship Individual
Incorporated within the last 12 months
Ownership
President/Owner:
Home Address:
City:
State:
Zip:
#2 Owner Name:
Home Address:
City:
State:
Zip:
#3 Owner:
Home Address:
City:
State:
Zip:
Credit Information
Bank Name:
Bank Officer's Name:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Account Number:
Federal ID#:
By clicking the submit button at the end of this form, you are hereby granting permission to All That Glass to use your credit information given on this form in processing you application.
Credit References (No utilities, phone, cable companies, please.)
Credit Reference #1
Company Name:
Account Number:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Credit Reference #2
Company Name:
Account Number:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Credit Reference #3
Company Name:
Account Number:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Your Questions or Comments:
The terms of sale have been fully explained to me by All That Glass and I agree and accept stated terms.
We will review your application and get back with you regarding your account. If your wholesale account is approved, we will send you an email with your password to use our wholesale online catalog.
