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New Customer Online Account Request

This form allows you to establish an account with us.  You will be set up as a COD account for the first year with no minimum purchase although By filling out this form completely you are establishing credit with us after 12 months and maintain a minimum balance of 2500.00 per year. Please allow 3-5 business days for your account setup.  We may contact you with further questions.

Online Account Request

*Required Fields
Enter Company Contact Information:
* Company Name
* Contact Name
* Billing Address
* City, State, Zip
*Phone:
Enter Ownership Information:
*Type of Business
*Name of Owner
*Social Security Number:
*Phone:
*Home Address:
*City, State, Zip
*Number of Years in Business
Enter Trade References: (Include 3)
* Company Name
* Address
* City, State, Zip
*Phone:
* Fax:
   
* Company Name
* Address
* City, State, Zip
*Phone:
* Fax:
   
* Company Name
* Address
* City, State, Zip
*Phone:
* Fax:
Enter Bank Reference:
* Bank Name
* Address
* City, State, Zip
*Phone:
* Fax:
   
Enter Online Account Info:
*E-mail:

NOTE: The above e-mail address wil be your login username.
*Password:
*Password Confirm:
Enter Accounts Payable Info:
* Accounts Payable Contact:
* Payment Personally Guaranteed
Agreement:

This application is a contract between the above named manufactures and the applicant.  The Manufactures shall maintain a purchase money security interest in all goods purchased by the Applicant pursuant to any credit extension issued hereunder.  All invoices unpaid according to terms of invoice are subject to a monthly finance charge at the rate specified by the invoice or any other rate as specified by notice to the applicant, Owner(s), and the undersigned Company authorize the receipt and the exchange of credit information and agree to be bound by the terms and conditions of this Application and to be liable for any and all changes on this account.  The above information and any other information submitted is given for the purpose of obtaining credit and is warranted to be true.  We understand that all orders are subject to approval and acceptance by Wooden Leaf Furnishings.  All statements made herein are true and accurate to the best of our knowledge.  We authorize the above companies to make any and all inquiries necessary for action on this credit application.  We hereby indemnify the above companies and their agents, from any liability resulting from their credit survey.

* I have read and agree to the terms of Wooden Leaf Furnishings
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1299 US Route 62 | Wilmot, Ohio 44689
PHONE: 330-359-7872

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