Funtastic Novelties Customer Information
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1CUSTOMER INFORMATION
MAILING AND SHIPPING INFORMATION
To what address do you want your orders shipped? (Please do not use a P.O. Box)
Business Name: ____________________________________________________ Attn: ________________________________
Address: ______________________________________________________________________________________________
City_____________________________________________________________ State: _________________ Zip____________
To what address do you want your mail sent?
Business Name: ____________________________________________________ Attn: _______________________________
Address: ______________________________________________________________________________________________
City: ____________________________________________________________ State: ________________ Zip____________
BUSINESS INFORMATION
What is the exact legal name of your business? __________________________________________________________________
Under what name does this business operate? ___________________________________________________________________
What is the name of your parent corporation? __________________________________________________________________
What is the physical address of the business? ____________________________________________________________________
City_____________________________________________________________ State: ________________ Zip____________
What type of business is this? _______________________________________________________________________________
Business phone ________________________ other phone #: ________________________ Fax #: ________________________
E-mail Address: _____________________________________________ Home Page: __________________________________
What is your Federal I. D. number? ______________________________ State Tax Exemption #: _________________________
ORDER AND PAYMENT INFORMATION
Who is the person ultimately responsible for payment? ____________________________________________________________
Who is the manager? _________________________________________ Manager Phone #______________________________
Who is authorized to place orders? __________________________________________________________________________
Who is the person we should contact regarding orders? ___________________________________________________________
On the rare occasion that we are out of an item, will you accept a substitution? __________________________________________
Do you want the item placed on backorder? ____________________________________________________________________
VISA or MasterCard Information:
OWNER INFORMATION
Names of Principles
Residential Address City/State/Zip
Phone #
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_________________________________________________________________________________________________
BANK REFERENCES
Name of Bank: __________________________________________________________________________________________
Address of Bank: _______________________________________________
City/State/Zip: _________________________
Bank Officer: __________________________________________________
Phone #: _____________________________
Account #: ____________________________________________________
Type of Account: _______________________
Account #: ____________________________________________________
Type of Account: _______________________
BUSINESS REFERENCES
Name: _______________________________________________________
Phone #: _____________________________
Address/City/State/Zip____________________________________________
Account #: ___________________________
Name: _______________________________________________________
Phone #: _____________________________
Address/City/State/Zip____________________________________________
Account #: ___________________________
Name: _______________________________________________________
Phone #: _____________________________
Address/City/State/Zip____________________________________________
Account #: ___________________________
I have read, understand, and agree to the Terms and Conditions included with this form:
_____________________________________________________________________________________________________
Signature
Title or Position
Date
FUNTASTIC NOVELTIES, INC.
* 4515 Industrial Road * Fort Wayne, Indiana 46825
800-348-0888 Orders
** 260-482-1566 Business ** 260-482-1568 Fax **
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Parent category: Business