Dicegames.com - Secure Online Vendor Application

New Account Application

To purchase our products at wholesale price, complete this application and click the "Send Application" button below to send it. Please FAX a COPY of your valid Vendor's License or State Resale Certificate, issued by your state, to 239-949-3653. If requesting that we extend to you terms of 30 days, please include a current list of business references below and allow 2-3 weeks for approval. Otherwise your order will go out C. O. D., or payment in advance. Applications with missing information or without a valid license will be considered incomplete and no order will be shipped. Your First order MUST be a minimum quantity of 48 games. Thank You.

Company Info:

State:

Vendor/Tax Identification #:

Federal:

EIN #:

Date:

Company Name:

Contact Person:

Phone:

Email Address:

Business Shipping Address		Business Billing Address Check if Same as Shipping

Address/P.O. Box:		Address/P.O. Box:

City:		City:

State/Province/Region:		State/Province/Region:

Country:		Country:

Zip/Postal Code:		Zip/Postal Code:

Phone:		Phone:

Fax:		Fax:

Type of Business:

Website Address:

If you wish to expedite your order, you may provide your credit card information below.

Card Type:	Mastercard Visa American Express Discover	Cardholder Name:

		Card Number:

		Expiration Date:

Check this box if applying for Net 30 terms. Please include a list of business references with up-to-date company information and fax numbers, and allow 2-3 weeks for approval.

Business References:

By checking this box, I acknowledge that I have read the Legal Notice and accept the Terms and Conditions set forth by George & Company LLC regarding Copyrights and Trademarks.

Your signature is required to verify you have read the Legal Notice regarding Copyrights and Trademarks.