FAX BACK TO: 323-584-1320
Stocking Dealer____ Designer_____Hospitality/Contract______
Business Name: _________________________________ DBA ____________________________
Name of Parent Co. (If Subsidiary ): _________________________________________________
Billing Address: (street)_________________________ (city,state,zip)____________________________
Shipping Address: _________________________________________________________________
Phone: __________________ Fax: ____________________Email:__________________________
Accounts Payable Contact:__________________________Tele#______________________Xt.___
Type of Business: ( ) Individual ( ) Partnership ( ) Corporation
Number of Years in Business: ______
Federal Tax Number: __________________, or Social Security Number: ____________________
Name(s) Of Owner(s): _________________________________ Title: ________________________
Home Address: __________________________________________________________________
Home Phone: ______________________ DL#_______________________________________
Name of Your Bank:_______________________________ Branch:_________________________
Address:_________________________________ Tel:_ ___________Fax:_________________
Acct#:_________________________________Contact:__________________________________
Please list below three active accounts with which you have credit terms stating complete names,
addresses, account numbers and phone numbers.
Name:______________________________Tel:_____________________Fax:__________________
Name:______________________________Tel:_____________________Fax:__________________
Name:______________________________Tel:_____________________Fax:__________________
INDIVIDUAL(S) RESPONSIBLE FOR PAYMENT OF ACCOUNT
The above information is for the purpose of opening an account with Nathan Anthony Furniture
manufacturing (“Company”) and is warranted to be true.
I/We hereby authorize Company to whom this information is given to investigate the references and
banks listed and/or attached hereto pertaining to my/our credit and financial responsibility.
I/We believe that my/our firm is financially able to meet any commitment I/we make and I/we assure
prompt payment of invoices according to the terms agreed upon. I/We understand that Company uses
Lyon Credit Services to help set up net/term accounts.
RETURN POLICY
All sales are final. Company accepts returns for inspection of manufacturing defects only at the customer’s expense. If a
manufacturing defect is determined, company will repair and replace merchandise and reimburse shipping expenses.
CLAIMS
Company is not responsible for freight or shipping damage from third party carriers (broken legs, nicks, scrapes, tears). If
you feel you have a claim for manufacturing defect, claims must be made within 10 days of receipt of goods. If no
claim is made within 10 days of receipt of goods, customer is considered to have Accepted the goods in saleable
condition and forfeits any future claims on said goods.
JURISDICTION
Any disputes arising out of this agreement shall be governed under California law and adjudicated in Los Angeles,
California.
TERMS AGREED TO: Net 30 LIMIT - $7,000 (Any late payments are subject to a 1.25% per diem late fee).
RETURNED CHECK POLICY: If your check is returned unpayable for any reason, you will be charged a $30.00 returned
check fee, plus any other costs associated with collecting balances due, including but not limited to, court costs, collection
agency fees and attorney fees.
Name (Print):_______________________Signature:__________________________(For Bank Use)
Title/Position:___________________ Date: _____________