The Electric Quilt Company

The Electric Quilt Company

500 Lehman Ave, #10 | Bowling Green, Ohio 43402
Phone: 419-352-1134
Website: www.electricquilt.com

Wholesale Account Application

BUSINESS INFORMATION
Date__________________ Legal Business Name __________________________________________________
Legal Owner(s) __________________________________________________________________________________
DBA (if applicable) ________________________________________________________________________
In business since _____________
Resale # (Vendor License or BN) __________________________________
Phone _______________________________ Fax ______________________________________
E-mail _______________________________________________
Website ______________________________________ We would like to be listed on the EQ website Retail Locator
Please check all that apply to your business: Brick & Mortar Web-Only Store Both
Quilt Shop Fabrics/Sewing Machines Long Arm Professional
Other_________________________________
Products will be for: Business Use Resale

SHIPPING ADDRESS
Street Address________________________________________________________________
City _________________________ State/Prov _______ Postal/Zip Code ___________________

BILLING AND CREDIT CARD ADDRESS (if different from shipping address)
______________________________________________________________________________
City _________________________ State/Prov _______ Postal/Zip Code ___________________
Manager _______________________________________________________________________
Others authorized to place orders ____________________________________________________

PAYMENT
All accounts must be prepaid with credit card.
Signed ____________________________________________ Date ________________________

TO BE COMPLETED BY EQ
Customer Number _________________________
REFERENCES

Please list three business references:

Name: ____________________________________________________________________________________________
Business: __________________________________________________________________________________________
Phone: ____________________________________________________________________________________________
Email: _____________________________________________________________________________________________
May we contact this reference? Yes No

Name: ____________________________________________________________________________________________
Business: __________________________________________________________________________________________
Phone: ____________________________________________________________________________________________
Email: _____________________________________________________________________________________________
May we contact this reference? Yes No

Name: ____________________________________________________________________________________________
Business: __________________________________________________________________________________________
Phone: ____________________________________________________________________________________________
Email: _____________________________________________________________________________________________
May we contact this reference? Yes No

CREDIT CARD INFORMATION

Type of Card: _______________________________________________________________________________________

Credit Card #: _______________________________________________________________________________________
Name on Card: ______________________________________________________________________________________
Exp. Date: __________________________________________________________________________________________
CID Code: __________________________________________________________________________________________
Billing address for card: ________________________________________________________________________________
Signature of card holder: _______________________________________________________________________________

PLEASE RETURN THIS FORM VIA:

Email: sales@electricquilt.com or Mail: 500 Lehman Ave., #10 Bowling Green, OH 43402