Company Information:

Legal Company Name:

Address:

Direct Phone Number:

Email Address:

Federal Tax ID Number (USA ONLY):

Social Security Number (USA ONLY):

Credit References:

Bank #1 Name:

Bank #1 Address:

Contact Name:

Phone Number:

Bank #2 Name:

Bank #2 Address:

Contact Name:

Phone Number:

Trade References:

We require a minimum of THREE (3) REFERENCES where you have credit established (not prepay accounts).

Company #1 Name:

Contact Name:

Title:

Email Address:

Phone Number:

Company #2 Name:

Contact Name:

Title:

Email Address:

Phone Number:

Company #3 Name:

Contact Name:

Title:

Email Address:

Phone Number:

Account Application Type:

Net 30 (must complete 3 prepay orders before terms are granted)

Prepay by check or ACH

Credit card (3.5% order processing fee will be added to your order)

Agreement & Digital Signature

I/We give consent to Humboldt Artisans Group to obtain any reports containing credit or personal information that is required in obtaining credit from Humboldt Artisans Group. I/We declare that the information given on this application is true and accurate in every aspect. This declaration is made for the purpose of obtaining credit from Humboldt Artisans Group and will remain confidential.

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