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Imagina Wholesale Credit Application |
See Imagina Wholesale/Reseller Information for information about Imagina's current trade distributors.
| Company (legal name): |
q Sole proprietorship q
Partnership q Corporation (state: ______, date incorp.: _______) |
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| DBA or trade name (if different):
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| Street address: |
City: | State: | Zip/post code: | Country: | |
| Mailing address (if different): |
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| Telephone: ( ) |
Fax: ( ) |
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| Name of contact individual: |
Telephone: ( ) |
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| Resale license number: |
State: | Federal tax ID #: | |||
| Name: |
Address: | Telephone: | Title: |
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| Bank: |
Address: | Telephone: | Account #: |
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| Company: |
Address: | Telephone: | Account #: |
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I/We certify that the information on this application is true and complete and provided for the purpose of obtaining credit terms. Imagina is authorized to make any inquiries deemed necessary to verify this information and to determine purchaser's creditworthiness at any time.
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Authorized signature X |
Title |
Date |
Send to: |
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| Imagina Productions, Inc. 2545 Warren Avenue N. Seattle, WA 98109-1836 U.S.A. |
+1-206-284-8381 | (telephone) | |
| +1-509 479-9347 | (fax) | ||
| imagina@msn.com | (email) | (12/06) | |
URL: http://ip1.com/imagina email: imagina@msn.com © copyright 1995-2008 Imagina Productions / IP1 Imagina and IP1 are registered trademarks of IP1 Corporation. |
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| revised: 21 Dec 2006 |