Credit Application | Eye Q Eyewear

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Credit Application

Account Information

Name of Legal Entity

Telephone

Fax

Bill-to-Address (Statement will be mailed here)

Street Address

City

State

Zip/Postal Code

Shipping address is different than billing address

Ship-to-Address

City

State

Zip/Postal Code

Exempt from Sales Tax?

Yes

Business Office Contact Person

Business Email Address

Business Organization

Either Federal ID or SSN is required.

Company Organization *

Sole Proprietor

Partnership

Corporation

LLC

State of Business Formation

Date of Business Formation *

Which will you be providing? *

Federal Tax I.D.(Preferred)

Social Security Number

Social Security Number *

Federal Tax I.D. Number *

Name of Business Owner #1 *

Telephone *

Name of Business Owner #2 if applicable

Telephone

If you are human, leave this field blank.

Account Information

Business Organization

WHAT OUR CLIENTS HAVE TO SAY

Mike DeMasi, VS Eyewear

Leonard Farmer, Optical Distributors

Andrea Nicholas Director of Optical Services, Michigan Eye Institute

Mitchell Makowsky, West Coast Distributor, Dickies Eyewear

Account Information

Business Organization

Mike DeMasi, VS Eyewear

Leonard Farmer, Optical Distributors

Andrea Nicholas Director of Optical Services, Michigan Eye Institute

Mitchell Makowsky, West Coast Distributor, Dickies Eyewear

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