New Customer Account Credit Application

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
consideration.

For additional questions, please contact us at 510-295-4838 or info@thewinenoire.com.

You can also download the form as a pdf and complete it offline here. When you complete the form please email it to info@thewinenoire.com. Please put the following text in the subject line: “New Customer Account Credit Application from [your company name]”.

    General Information

    Today's Date:

    Business type:

    Name of Business:

    DBA (if different from above)

    Business EIN:

    Year established:

    If incorporated, under which state:

    Street Address:

    City:

    State:

    Zip Code:

    Business phone:

    Business fax - optional:

    Email Address **Required Field**:

    Name on License:

    License Number:

    Business Owners

    Owner #1 Information

    Name:

    Street Address:

    City:

    State:

    Zip Code:

    Phone Number:

    Email Address:

    Social security number:

    Percent ownership:

    Owner #2 Information

    Name:

    Street Address:

    City:

    State:

    Zip Code:

    Phone Number:

    Email Address:

    Social security number:

    Percent ownership:

    Owner #3 Information

    Name:

    Street Address:

    City:

    State:

    Zip Code:

    Phone Number:

    Email Address:

    Social security number:

    Percent ownership:

    Owner #4 Information

    Name:

    Street Address:

    City:

    State:

    Zip Code:

    Phone Number:

    Email Address:

    Social security number:

    Percent ownership:

    Financial Information

    Name of Accounts payable contact:

    Contact email:

    Contact phone number:

    Email to mail statements to:

    Mailing address to mail statements to:

    Check here if address is the same as above in general information

    Estimated sales in the next 6 months:

    Amount of credit requested:

    Do you have lines of credit with other distributors?
    YesNo
    If yes, which ones
    Southern Glazer Wine and SpiritsEpicOther
    Other:

    Are there any lawsuits pending?
    NoYes - I am the plaintiffYes - I am the defendant

    References

    Names of business/trade references

    Reference # 1

    Name:

    Street Address:

    City:

    State:

    Zip Code:

    Phone Number:

    Email Address:

    Reference # 2

    Name:

    Street Address:

    City:

    State:

    Zip Code:

    Phone Number:

    Email Address:

    Terms and Conditions

    Please read the following carefully before accepting.

    Applicant represents that applicant has read, understands and consents to the provisions of the Credit Agreement set forth on the following pages of this Credit agreement. Applicant authorizes investigation and disclosure of information of credit application including checking credit history with credit bureaus and others. All payments will be expected in accordance with NRS 369.485, otherwise COD will be expected.


    I hereby warrant that the above information is true and correct and is furnished for the purpose of obtaining credit. I hereby agree that The Wine Noire, LLC may investigate our record and that, if an account is opened, The Wine Noire, LLC may furnish information regarding this account to credit reporting agencies and others who may properly request such information. My signature below authorizes any and all agencies listed on this application as a credit reference to release information about our company’s history with them.


    CREDIT TERMS: Net 30 days. Interest of 1 1⁄2 percent per month shall accrue on any unpaid balance of applicant’s account, which is not paid to the company according to the terms of payment specified by the company. In the event that the account is placed with a collection agency or attorney for collection, applicant agrees to pay all costs of collection, including reasonable attorney fees, whether or not a lawsuit is commenced.


    In the event an action is commenced, applicant hereby submits to the jurisdiction of the courts of California. Applicant hereby authorizes the company to obtain credit information from any source and further authorizes those credit sources to provide credit information to the company.


    Applicant understands that delinquent payments may jeopardize my credit privileges.

    Applicant

    Applicant's Name:


    By clicking this box the applicant accepts the terms and conditions

    Distributor

    Distributor's Name: