Dilmaghani - 540 Central Park Avenue, Scarsdale, NY 10583
(914) 472-1700 - www.dilmaghani.com

APPLICATION FOR WHOLESALE BUYERS - PAGE 1 of 2
Company Name______________________________________________________________________________
Attention/Contact ____________________________________________________________________________
Mailing Address _____________________________________________________________________________
City _________________________________________State _______________________ Zip_______________
Shipping Address ____________________________________________________________________________
City ___________________________________________State _____________________ Zip_______________
County where business is located ______________________________________________________________
Telephone No. (____) _____-________ - Fax No.(____) _____-________ Email Address__________________
Federal ID No. ____________________________ Resale No. __________________________ State_________
 

ORGANIZATION
 
[_] Corporation [_] Partnership [_] Proprietership [_] Individual [_] Other_______________________________
Date of Formation/Incorporation _______________, 19____ State of _____________________

List home address and home telephone No. of all officers, partners, owners or principals; list name of spouse (whether actively involved in business or not); list names of children or other relatives active in business or owning interest in business.

Title----Name--------------------------------Home Address ---------------------City----------------------State---Zip-----------------Area---------Home Phone
___ _______________ _______________ ___________ ___ _______ (____) ____ ____
___ _______________ _______________ ___________ ___ _______ (____) ____ ____
___ _______________ _______________ ___________ ___ _______ (____) ____ ____
___ _______________ _______________ ___________ ___ _______ (____) ____ ____
___ _______________ _______________ ___________ ___ _______ (____) ____ ____

List any past or present d/b/a or assumed business names, related company, subsidiary:
_____________________________________________________________________
Have you ever closed a location or gone out of business? If so, please list former name(s) / location(s):
_____________________________________________________________________
_____________________________________________________________________
 

FACILITIES
  Showroom Address (if different from above)

__________________________ _________________ _____________ ______ (___) ___-_____
address -------------------------------------------city---------------------------------state---------------------zip----------------phone
Please describe your type of business/products/services:
__________________________________________________________________________________________
Other products: [_] Carpeting [_] Machine Made Rugs [_] Furniture [_] Fabrics [_] Other__________________
Landlord of business premises: ________________________________________ Phone (____) ____-_______
Branch Location Address: ____________________________________________________________________
Landlord of Branch Location ___________________________________________ Phone (____) ____-_______
 

 

APPLICATION FOR WHOLESALE BUYERS - PAGE 2 of 2

 

TRADE REFERENCES
Please list four references - Oriental rug suppliers preferred.
  Company Name --------------------------------Address -------------------------City------------------------------State---------------Area---------Phone
_____________________ ________________ ___________ ______ (____) __ ______
_____________________ ________________ ___________ ______ (____) __ ______
_____________________ ________________ ___________ ______ (____) __ ______
_____________________ ________________ ___________ ______ (____) __ ______
 

BANK REFERENCES
 
 _________________ ______________
Bank Name
_________________ ______________
Address
_________________ ______________
City/St/Zip		 (____) ____-________ (____) ____-________
Bank's Phone ---------------------------------- Fax
 ____________________________ ________
Acct # with Bank------------------------------------------------- # Years

__________________________________________________________________
Contact at Bank

 _________________ _____________
Bank Name
_______________________________
Address
_______________________________
City/St/Zip

 (____) ____-________ (____) ____-________
Bank's Phone ---------------------------------- Fax
 ____________________________ ________
Acct # with Bank------------------------------------------------- # Years

__________________________________________________________________
Contact at Bank
 

FILINGS
  Please list any financing statements filed:
Secured Party--------------------------------------------------Collateral----------------------------------------------When Filed ------------Where Filed-----
________________________ ______________________ (___/___/_____) ___________
________________________ ______________________ (___/___/_____) ___________
________________________ ______________________ (___/___/_____) ___________
Please indicate if any of the above financing statements include after acquired collateral.
 

ATTACHMENTS NECESSARY TO COMPLETE APPLICATION
  1) Financial statements or business tax returns for the three most recent years of operation.
2) Photographs of exterior and interior of your business premises - snapshots are acceptable.
 

CERTIFICATION
 
I, ______________________________(individual), certify that I am the _______________(title) of ___________________________________(name of business entity) and that all of the information and representations contained herein are true and submitted for the purpose of obtaining credit. I acknowledge that if credit is extended to the undersigned company, all past due amounts will bear interest at the maximum rate allowed by law. I hereby authorize the release of all credit information from the above companies to Dilmaghani.

Signature __________________________________________

Name Printed __________________________ Title __________ Date (____/____/_____)
 

Return application original and all necessary attachments by mail or courier (not fax) to:
DILMAGHANI - 540 Central Park Avenue - Scarsdale - NY - 10583