Manufactures Direct Apparel - Inventory Management

		CREDIT APPLICATION Click here to download PDF version and FAX it in or fill out the electronic form below.

  Name of Account
  Street Address         Address 2
  City       State       Zip

  How Long In Business

  Applicants First Name      Applicants Last Name

  Social Security or Fed ID#       Re-Sale Number ( CA, AZ, OH )

  E-Mail       Phone with Area Code     Fax Number

Home Address of Applicant
City State Zip

TRADE REFERENCES

1
  Name       Account #
  Telephone w/Area Code ;      Fax w/area code

2
  Name       Account #
  Telephone w/Area Code       Fax w/area code

3
  Name       Account #
  Telephone w/Area Code       Fax w/area code

BANK REFERENCE

  Bank Name      Account Number
  Bank Address, Street, City, State, Zip
  Bank Contact      Telephone w/area code

AUTHORIZATION TO MANUFACTURES DIRECT APPAREL

I understand by submitting this Secure Members Application to Manufactures Direct Apparel I am authorizing Wilzoni to run a full investigation of my Credit History including but not limit to obtaining a current Consumer Credit Report. I am also authorizing Manufactures Direct Apparel to contact all references listed within and authorize those references to releases information about my credit experience with them.

I Authorize Manufactures Direct Apparel access to all information available from current creditors.
I Do NOT Authorize Manufactures Direct Apparel access to all information available from current creditors.

Special Request

You will be contacted by Manufactures Direct Apparel once a determination has been made.