Thank you for your interest in becoming a valuable customer with The Wine Noire. This application should be completed by the department or individual who is responsible for payment.
All pages of this credit application must be completed and signed for approval
For additional questions, please contact us at 510-295-4838 or firstname.lastname@example.org.
You can also download the form as a pdf and complete it offline here. When you complete the form please email it to email@example.com. Please put the following text in the subject line: “New Customer Account Credit Application from [your company name]”.