Bioworld Merchandising

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Payment Terms	Net 30 days COD Company Check COD Cashiers Check Credit Card
Customer ID (if applicable) :
First Name :	Middle Name :
Last Name :
Company:
Address :
City :
Country/Region :
State/Territory :
ZIP :
Email :
DayTime phone :	- - Format: 111-111-1111
Fax :	- - Format: 111-111-1111
Promotional ID (if applicable) :

*Registration will be processed within 48 business hours.

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If you selected Net 30 days or COD Company Check terms then the below information is required. Otherwise you can scroll to the end and Submit the application.
Type of Organization: Corporation Partnership individual
Years in Operation:
Nature of Business: Apparel Retail Accesories Retail Distributor
Federal Tax ID:
D&B#:
Is Financial Statement Available?: Yes No ***If available please fax to: Credit Department 972-812-2812
Officers and/or Owners:
Name:	Title:	Phone:	SS#:
Name:	Title:	Phone:	SS#:
Person to Contact for Payments:
Name:	Title:	Phone:	Email:
AP Check Cycle: Weekly Bi-Weekly Monthly Other
Name of Bank: Address:
Bank Account#: Bank Phone:
Bank Contact:
Trade References:
Company Name:	Address:		Phone:
Company Name:	Address:		Phone:
Company Name:	Address:		Phone:
Check here to Agree to Terms
By checking this checkbox, I certify that to the best of my knowledge and belief, the above credit information is correct. Furthermore, I authorize the release of credit information for the purpose of establishing credit with Bioworld Merchandising. Credit approvals will typically take 1 – 5 business days depending on information response time. If the application is denied, a personal guarantee may be required until satisfactory payment history is established with Bioworld Merchandising. Disclaimer: IF CREDIT IS EXTENDED AS A RESULT OF THIS APPLICATION. I HEREBY ACKNOWLEDGE AND AGREE TO YOUR TERMS WHICH ARE: Terms on all accounts are net 30 days from invoice date unless Bioworld authorizes otherwise in writing. If payment is not received when due, your account will be considered delinquent and subject to loss of credit privileges. A finance charge of 1.5% will be applied to your account for each month past due. In the event necessary to commence collection activity, I/We agree to pay collection agency fees and/or reasonable attorney fees and all cost that are incurred as fixed by the court. If a suit is brought, the venue may be laid in Dallas County, Texas.