Centennial Fine Wine & Spirits

RESTAURANT ON-LINE CREDIT APPLICATION

ALL CHARGES INCURRED FROM THE 1st THROUGH THE 15th OF EACH MONTH MUST BE PAID BY THE 25th OF EACH
MONTH. ALL CHARGES INCURRED FROM THE 16th THROUGH THE END OF THE MONTH MUST BE PAID BY THE 10th OF THE
NEXT MONTH. A COPY OF YOUR PERMIT CERTIFICATE AND TAX IDENTIFICATION SALES
CERTIFICATE WILL ALSO NEED TO BE PROVIDED.

Permit Information

Permit Number: *

Permit Number(2): *

Expiration: *

Business information

Business Trade Name: *

How long at this location:

How many years in buisness:

Do you own or operate any other restaurants /bars:

Purchasing Contact

Name:

Phone #:

Email:

Accounts Payable Info

Name:

Phone #:

Email:

Delivery Information

Street Address:

State:

City:

Zip:

Invoice mailing address

Street Address:

State:

City:

Zip:

Ownership

Sole Ownership, Partnership or Corporation:

Has the company ever declared Bankruptcy?:

Name of Primary Officer:

Title:

Home Street Address:

City:

State:

Zip:

Bank Information

Bank Name:

Bank Phone Number:

Bank Contact Person:

Credit References

1. Name of Company:

Phone Number::

2. Name of Company:

Phone Number::

Requested Method of Payment

Method::

Credit Terms

Electronic Funds Transfer

C.O.D.

Fintech

I certify that to the best of my knowledge the above information is true and correct.

(Type name and title below)

Name and Title: *

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Subscribe to
our podcasts

Centennial is a proud member of the Wine and Spirits Guild of America, Texas Package Stores Association and American Beverage Licensees.
This website © 2008, Centennial Fine Wine and Spirits.
Website created by AdWise Group

Website Map | Contact Us | COS Form | Inventory Search