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(Remember, all fields marked red are required.)
ACCOUNT INFORMATION
The following information will be used for billing and contact purposes.
COMPANY NAME
CONTACT NAME
ADDRESS
Address Line 2
CITY
STATE
AL
AK
AR
AZ
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WV
WI
WY
ZIP CODE
PRIMARY PHONE
Alternate Phone
Fax Number
EMAIL ADDRESS
(All account correspondance will be emailed to this address.)
BUSINESS INFORMATION
BUSINESS TYPE
Proprietorship
Partnership
Corporation
CORPORATION NAME
FEDERAL TAX ID
RESELLER ID
YEAR ESTABLISHED
Date Of Purchase
(If business has new owner)
Type of Industry
Gourmet Foods
Gift Shop
Department Store
Restaurant or Catering
Gift Baskets
Other:
Time of Peak Sales
Year Round
Seasonal
Undetermined
REQUESTED TERMS
COD
Credit Card
Net 30
COMMENTS FOR MAGGIE LYON
If you have any comments, questions or concerns reguarding your application, please let us know.
EXISTING ACCOUNT
If you do not have an existing account with Maggie Lyon, please skip to CREDIT REFERENCES below.
If you already have an account with Maggie Lyon, please provide your account number below, then submit your application for activation.
ACCOUNT NUMBER
Remember, your account number can be located at the top of any Maggie Lyon invoice, directly above the SOLD TO name and address.
CREDIT REFERENCES
#1
COMPANY NAME
Contact Name
Address
PHONE
Fax
ACCOUNT NUMBER
#2
COMPANY NAME
Contact Name
Address
PHONE
Fax
ACCOUNT NUMBER
#3
COMPANY NAME
Contact Name
Address
PHONE
Fax
ACCOUNT NUMBER
#4
COMPANY NAME
Contact Name
Address
PHONE
Fax
ACCOUNT NUMBER
#5
COMPANY NAME
Contact Name
Address
PHONE
Fax
ACCOUNT NUMBER
#6
BANK REFERENCE
Contact Name
Address
PHONE
Fax
