WildBirdsOnline Wholesale Credit Application

WildBirdsOnline is a division of The Wild Bird Store, Inc. Phone: (520) 322-9466 Fax: (520) 908-9752 info@wildbirdsonline.com

Name and address of Business: ________________________________________ ________________________________________ ________________________________________

Type of Business (check only one) ( ) Proprietorship ( ) Partnership ( ) Corporation Date business was established ___/___/___

Phone # - ( ) ____-_____ Fax # - ( ) ____-_____ E-mail -

Business owner - Name _________________ Title___________________ SS#_________________

Authorized Contact person - Name _________________ Title___________________ SS#_________________

Trade References:

1.

Name ________________Title___________________

Name of Business -

Address - ________________________________ ________________________________ ________________________________

Phone -

Your account # -

2.

Name _________________ Title___________________

Name of Business -

Address - ________________________________ ________________________________ ________________________________

Phone -

Your account # -

3.

Name _________________ Title___________________

Name of Business -

Address - ________________________________ ________________________________ ________________________________

Phone -

Your account # -

Bank References:

Name of bank -

Account # -

Contact Person -

Bank Phone # - ( ) ____-_____

Were you ever involved in a bankruptcy ( ) Yes ( ) No ? If yes, give details ________________________________________________

Feel free to attach any other information which will aid us in establishing credit for your company. Upon approval of this application, it is understood that the terms of payment are to be strictly adhered to. Should the account become delinquent beyond thirty days, no further shipments will be made until account is paid in full. Past due balances are subject to a monthly service charge of 1.5 % (18% per annum). If the account becomes delinquent, we agree to pay any legal or collection fees expended by the Wild Bird Store, Inc. arising from collection of the account. I agree to notify the Wild Bird Store, Inc. immediately of any change of ownership of this business. Please attach a copy of your state resale tax ID #.

………………………. (Print name clearly)

………………………. (Authorized signature)

Date ____/____/_____