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PRINT THIS WHOLESALE APPLICATION FORM
and Fax to 1-206-494-7843 or email to info@cupcouture.com
 
  Name of Business: _____________________________________________________________________  
     
  Preferred Payment: VISA____________ MASTER CARD ____________CHECK _________  
     
     
  ACCOUNTS PAYABLE INFORMATION IF PAYING BY CREDIT CARD:  
  Contact: ______________________________________ Card Number:____________________________________  
  Phone/Ext: ____________________________________ Name on Card:____________________________________  
  eMail: _________________________________________ Expiration Date:__________________________________  
  Resellers/Tax Certificate Number: _________________________ CVN Number:____________________________________  
     
  SHIP TO BILL TO  
  Name:______________________________________ Name:______________________________________  
  Company:______________________________________ Company:______________________________________  
  City/State:______________________________________ City/State:_____________________________________  
  Postal Code:______________________________________ Postal Code:____________________________________  
  Fax:______________________________________ Fax:______________________________________  
  eMail:______________________________________ eMail:______________________________________  
     
     
  ADDITIONAL PACKAGING OPTIONS (yes or no):
Barcoding (we will call you) _____________ Hang Tab _________________
 
     
  IF PAYING BY CHECK: 2 TRADE REFERENCES ARE REQUIRED. Payment terms are 15 days from Receipt of invoice.  
  Trade References:  
  Company Name:______________________________________ Company Name:_________________________________  
  Contact Name:______________________________________ Contact Name:___________________________________  
  Phone Number:______________________________________ Phone Number:___________________________________  
  Account Number:______________________________________ Account Number:_________________________________  
     
  Place a Wholesale Order  
  coffee cup sleeves  
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