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Contact Information
Buyer First Name *
Buyer Last Name *
Company Name *
Address *
City *    State *    Zip *
Country *
Phone *    Alt. Phone
E-Mail *
AP Contact Name *
AP Contact E-Mail *
AP Contact Phone *

Other Store Information
Company Type * Corporation
Individual (SSN):
Owner's Name *
Owner's Address *
City *    State *    Zip *
Type Of Business *
Date Started *
Federal Tax ID # *
State Reseller Permit #

Type Of Location *
Shopping Mall Strip Mall Free Standing Non-Profit
Other: Please Explain
Please check all that apply:
Please check all that apply and at least 3 references must be selected:
Evergreen Enesco Collins
Creative Co-Op Demdaco Dicksons
Giftcraft Inc. Natural Life Two's Company
Kurt S. Alder, Inc. P. Graham Dunn Midwest-CBK
Mud Pie Ganz Precious Moments
Primitives by Kathy Yankee Candle Roman
Other (1): Name    Phone    Fax
Other (2): Name    Phone    Fax
Other (3): Name    Phone    Fax
By checking here I certify that all of the above information is true *
By checking here I agree to the terms and conditions *
Rep Name:

Terms and Conditions

All accounts are checked in advance, or credit card is needed until a credit application has been completed, reviewed and approved. If any indebtedness incurred pursuant to this request for credit is not paid in full when due, the undersigned agrees to pay all costs of collection, including a reasonable attorney's fee. Any unpaid balance shall bear interest at the rate of 1.8% per month or the maximum rate permitted by applicable law, until paid in full.

Accepting this agreement indicates your compliance of the terms and conditions as stated. In addition, you authorize Christian Brands®, Inc. to make any and all inquiries necessary to process the credit application.