MURPHY’S MAGIC SUPPLIES
CONFIDENTIAL CUSTOMER INFORMATION (Application to Purchase Wholesale)
Required Fields are in RED --press <TAB> to progress through fields--
Company Name:
 Owner/Partners/Corporate Officers
Address: City: State/Country: Postal Code:
 Fax Number:
E-Mail: Phone Number:
WebSite:
PLEASE PROVIDE THE FOLLOWING INFORMATION, ALONG WITH A COPY OF A VALID RESALE LICENSE AND BUSINESS LICENSE: (our fax: (916)853-9494)
Years In Business:
Federal I.D. #
Resale #:
Please Check One: Sole Proprietorship: Partnership: Corporation:
If Corporation, list state of Incorporation :

Principal Owner(s): SSN#

Principal Owner(s): SSN#

Manager: Other Pertinent Name(s):

Accts Payable Name:

Bank Name: Account Number:

Address:

How did you hear about Murphy's Magic Supplies?

BUSINESS REFERENCES (Two Required)

1) Firm Name Phone Number with Area Code
Complete Address

2) Firm Name Phone Number with Area Code
Complete Address

3) Firm Name Phone Number with Area Code
Complete Address

PERSONAL GUARANTEE ( REQUIRED)

I certify that all statements made in this application are correct to my knowledge.
(Please Check to Acknowledge)

I hearby authorize Murphy’s Magic Supplies to investigate the references listed pertaining to financial responsibility. In consideration of extension of credit by Murphy's Magic Supplies, I agree that if the terms of sale are 30 Days Net there will be a late charge of 1 1/2% (18% APR) ($5.00 Minimum late payment charge). Murphy's Magic Supplies will charge $25.00 per returned check.  Murphy's Magic Supplies may also pursue in court for up to 3 times the amount of the bad check not to exceed $1,500.00 plus a bad check charge, court costs and/or attorney's fees when so ordered by the court

 Yes, I agree No, I disagree
By choosing "Yes," you acknowledge that you have read and understand the information provided. Along with the information above, this will act as a digital signature. By choosing "No," you ask that this application be disregarded and will not be processed.

Date(mm/dd/yyyy):

Signature:____________________________________________________(If faxing)
Additional Information:
If you have any information you feel should be used in consideration of your application, type it here...