Untitled Document

Carroll Fine Art - Trade Account Application Form

Dealer Application Form

Becoming a Carroll Fine Art Dealer provides you with access to our full spectrum of services and benefits. Available to qualified businesses in the resale trade only.

Company Name

Legal Name of Business

Trade Name (if Different)

Mailing Address

Delivery Address (if different)

Address 1:

Address 2:

City:

State:

Province:

Zip/Postal Code:

Country:

Business Phone Number:

Fax Number:

E-mail Address:

Web Site Address:

Resale Certificate Number:

Principal Contact

Principal Contact Name:

Job Title:

Phone Number (if different):

Address (if different):

E-mail Address:

Financial Responsibility

Please complete the section(s) below that applies to the form of ownership for your business:

Individually Owned Name of Owner:

Corporation

President, CEO, or
Managing Shareholder:

Partnership

Managing Partner:

Franchise

Parent Company:

Address:

Phone Number:

Other

Please explain and
provide principal's name:

For the individual named above, please provide:

Home Address:

Home Phone:

Is this person a full-time employee of this business?

Yes No

If not, please indicate where the owner can be reached during business hours:

Business Name:

Address:

Phone Number:

Business Description

Date Business Established:

Which of the following best describes your business (please check one):

Gallery Gallery and Frameshop Framer

Designer Other (please describe):

Which of the following best describes the location of your business (please check one):

Shopping Center Business District Residential

Rural Other (please describe):

Please indicate which products and services you offer by filling in the approximate percentage of your total sales each category represents:

Limited Edition Prints:	%	Framing:	%	Home Furnishings:	%
Limited Edition Canvas:	%	Posters:	%	Misc. Collectibles, Gifts:	%
Open Edition Prints:	%	Original Graphics:	%	Plates, Porcelain, Pewter:	%
Original Art	%	Books:	%	Other:	%

Information about your building or space:

Total Square Feet:

Retail Display Area
Square Feet:

Ownership:

own lease

Number of Employees:

Other Outlets:

Number:

List Addresses:

Annual Retail Sales:

This Location:

All Locations:

How do you plan to display Carroll Fine Art prints?

Note any special billing or shipping instructions:

Person responsible for processing payments for your company:

Name:

Phone Number:

Person responsible for purchasing inventory for your company:

Name:

Phone Number:

Person filling out this application: Name:

Phone Number:

Credit Information

Tax ID Number
(as applicable):

Social Security No:

Federal Tax ID No.

Declared Bankruptcy in the past 7 years?

Yes No

If yes, when?

Bank:

Name:

Branch/Office:

Contact Name/Title:

Contact Phone Number:

Account Number:

Account Type:

Trade References:

Company Name:

Contact Name / Title:

Contact Phone Number:

Address:

Account Number:

Company Name:

Contact Name / Title:

Contact Phone Number:

Address:

Account Number:

Company Name:

Contact Name / Title:

Contact Phone Number:

Address:

Account Number:

Credit Limit Requested (check one):

None/C.O.D $500 $1,000

Other (please specify):

Authorization and Approval

I represent and warrant the information contained in this Dealer Application to be true. I have the authority on behalf of the above applicant to complete this form. I hereby authorize Carroll Fine Art, or any credit bureau or investigative agency employed by Carroll Fine Art, to investigate the references herein listed or statements or other data obtained from me or from any other person regarding the applicant's credit or financial responsibility.

Entering your e-mail address below signifies your agreement to the above terms.

E-mail Address:

Name:

Title:

Date: