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Wholesale Account Application

     

Please print this page. 

Fill out and sign the form, then mail or fax to: Jukado  International, LLC.
  1230 E. Lexington Ave.
   Pomona, CA 91766

Phone:

800-535-7573

Fax: 

909-803-9301

Company Name: 

Address:   

Name of Officer/Contact Person:   

Phone: (             )      

Fax: (           ) 

Email Address: 

Check One:  ? Proprietorship     ? Partnership     ? Corporation    Tax ID#:  

Proprietorship or Partnership: 

Name of Owner/s 

Home Address 

City 

State 

Zip 

SSN# 

1. 

2. 

Attach a copy of proof of establishment such as Business License, Occupational License or Sale Permit. 

  

 I/We certify that all statements given are true and complete to the best of our knowledge. 

Authorized Signature (above)                                  Date 

Authorized Signature (above)                                   Date 

  

  

Please print name in space above 

Please print name in space above 

 For us to accept your personal or company checks, please fill out the form below. 

Name of Bank: 

Branch:   

Account No. 

Routing No. 

Address: 

Phone: (             )      

Trade References: 

1. 

2. 

3. 

 

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