WHOLESALE APPLICATION

(This is not a credit application) Note: If you are a current Hakatai wholesale customer, you do not need to fill out this form. To gain access to the “to the trade” portion of the website, please email blc@hakatai.com

Date : 10/13/2008

BILLING ADDRESS	SHIPPING ADDRESS (if different than billing)
* Company Name:	Company Name:
* Contact Name:	Contact Name:
Title:	Title:
* Address:	Address:
* City:	City:
* State:	State:
* Zip:	Zip:
* Phone: format ###-###-####	Phone: format ###-###-####
Fax: format ###-###-####:	Fax: format ###-###-####
* Email:	Email:
Website:	Website:

* How would you prefer to receive your invoices - via email, fax or postal mail? :


* Who is to receive the invoices at your company? (provide name as well as email or fax number) :


* Type of business :


How did you find us? :


 

Please provide us with as much of the following information as possible:
Federal Tax ID#
Resale Certificate#
Trade License#
Specify Type
Website Address
Other proof that you are a bona fide company in or related to the tile trade: