** BILLING ADDRESS & CONTACT INFORMATION **

BILLING ADDRESS & CONTACT INFORMATION
Company Name:
Tax ID Number:
Accounts Payable Name:
Email Address:
Street Address:
City:
State/Province:
Postal Code:
Country:
Telephone:
Facsimile:
Company URL:

SHIPPING ADDRESS & CONTACT INFORMATION
Company Name:
Tax ID Number:
Contact Name:
Email Address:
Street Address:
City:
State/Province:
Postal Code:
Country:
Telephone:
Facsimile:

OWNER CONTACT INFORMATION
Type of Business:
Years in Business:
Type of Ownership:	Corporation Partnership Proprietorship
Parent Company (if subsidiary):
NAME OF OWNER(S)	ADDRESS

Owner(s) Phone:

CREDIT REFERENCES *List at least 3 references with whom you have done business for at least 1 year (US firms only)
Reference #1:
Company:
Phone:
Fax:
Account#:
Reference #2:
Company:
Phone:
Fax:
Account#:
Reference #3:
Company:
Phone:
Fax:
Account#:

Fax your completed form to:

(510) 743-4161

Mail your completed form to:

The Toy Palace
230 Glen Crest Dr.
Moore, SC 29369

Signature of Proprietor, Partner or Corporate Officer

Title:
Date:

* Applicant’s signature above is requesting Net 30 terms and authorizes JKR Enterprises, DBA The Toy Palace to request payment for purchases made by its designated employees on behalf of the above Institution. Applicant attests financial responsibility, ability and willingness to pay our invoices in accordance with our terms. Should Applicant default in any payment(s), JKR Enterprises, DBA The Toy Palace shall have the right, without notice, to declare all invoice amounts due and payable. If all or any part of this account should become overdue and placed in the hands of another party for collection, Applicant agrees to pay reasonable attorney fees, collection fees, and other expenses incurred by JKR Enterprises, DBA The Toy Palace as permitted by law. This application for credit has been carefully read by the above-authorized Applicant and is to the best of my knowledge complete and accurate.