Xistis Wholesale Credit Form

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W H O L E S A L E C R E D I T A P P R O VA L F O R M To qualify for Net 15 or Net 30 credit terms, please fill out this form and email it to greetings@xistis.com ] . If you have any additional questions or information, please do not hesitate to call our studio at 208 . 267 . 2187. Thank you for your business and support. COMPANY PROFILE Client Name

Representative

Business Name

DBA

Street Address

Business Type:

Corp.

City

State

State of Incorporation

Zip

Tax ID - EIN Number:

Phone

Fax

Proprietorship

Partnership

STORE OWNERSHIP Name

Address

Phone

City

Social Security:

State

Zip

BANK REFERENCE Name of Bank Phone Street Address City

State

Zip

TRADE REFERENCES Company Contact

Address Phone

City

Company Contact

State

Zip

State

Zip

Address Phone

City

CREDIT CARD AUTHORIZATION Card Type

Visa

Mastercard

American Express

Card Number

Discover

Other

Expiration Date:

Name on Card Billing Address

City

State

Zip

The undersigned authorizes the above banks to release credit information to Capael Studios - SCS LLC. Signature

Account No.:

Date