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SCHAFF PIANO SUPPLY

1370 Ensell Road, Lake Zurich, IL 60047


Phone 1-800-747-4266 (847)438-4556 Fax (847)320-1390
info@schaffpiano.com
DATE
APPLICATION FOR ACCOUNT

BILLING ADDRESS PERMANENT SHIPPING ADDRESS


(If different from billing address)
Name of Firm or Andrés Ferrari Bridget Williams
Individual

Address Inclán 2941 601 Brickell Key Dr.


Suite 900
City, State, Zip Code Ciudad Autónoma de Buenos Air Miami, FL 33131
Country Argentina United States

Phone # E Mail ferrariae@gmail.com


Mobile # +54 9 11 4095 8878 (Invoices will be sent to you via email
Fax # unless otherwise requested)
Web Site
Accounts Payable Contact

OWNERSHIP
Corporation Owner's Name
Partnership Date Incoporated
x Individual (Please Supply S.S. #) Tax I.D. or S.S. #
Illinois Resale #

Nature of Business
Years in Trade
If Current Student / Instructor or School Student

PREFFERED METHOD OF PAYMENT


Cash With Order x VISA / MC / AMEX / DISCV
C.O.D. Open Account -Net 30 Days
(Must complete application to qualify)

SPECIAL INSTRUCTIONS

PLEASE INCLUDE A BUSINESS CARD OR LETTERHEAD WITH THIS APPLICATION

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