Text Box: Summer Infant, Inc. Customer Profile

Customer Profile

Company Name
Phone Number
Fax Number
Current Customer New Customer Retailer Wholesaler
Buyer Name & Number
Planner Name & Number
Traffic Contact Name & Number
A/P Contact Name & Number
Email Address

Bill To Address: Line 1:
  Line 2:
  City:
  State:
  Zip:

Ship To Address: Line 1:
  Line 2:
  City:
  State:
  Zip:

Tax ID Number:
Preferred Shipping Method:
Routing Guide: Yes No
  (Default is FOB RI via FEDEX Ground)
Backorders Allowed: Yes No
Website:
(Internal Use Only) Customer ID:
Account Type
Please Check
Specialty Store
Buying Group
Etailer
Cataloger
Baby Proofer
Toy Store
Drop Ship - DC
Drop ship - Direct
Drop Ship - Both
Department Store
Home Center
Grocery Store 
Drug Store
Mass Merchant
Military
Canada - Mass Merchant
Canada - Independents
Canada - Drop Ship
Canada - eTailers
Canada - Catalogers
International
Closeout/Off Price Store
Miscellaneous

Order Transmission Method:
Email Fax EDI Other

Terms Requested :
Prepaid Credit Card Wire Transfer NET Terms Credit Limit NET Terms Credit Card
Credit Line Requested:

Credit Card Information:
Card Type: Visa Mastercard American Express
Card Number: Expiration Date:
I am an authorized user on the above card and give permission to bill my credit card when requested.
 
Print Name: __________________________ Signature: _______________________________

Credit Card Billing Address: Line 1:
Line 2:
  City:
  State:
  Zip:

Have you ever filed for bankruptcy? Yes No
If Yes, which? Personal Business
Date Filed: Status:

Trade References:
Reference 1:  
Name:
Contact Name:
Phone Number:
Fax Number:
Account Number:
Address: Line 1:
  Line 2:
  City:
  State:
  Zip:

Reference 2:  
Name:
Contact Name:
Phone Number:
Fax Number:
Account Number:
Address: Line 1:
  Line 2:
  City:
  State:
  Zip:

Reference 3:  
Name:
Contact Name:
Phone Number:
Fax Number:
Account Number:
Address: Line 1:
  Line 2:
  City:
  State:
  Zip:

Customer Authorization:
I/We hereby authorize Summer Infant, Inc. to obtain information from our Bank/Financial Institution regarding the mentioned account(s).
 
Signed: ____________________________ Date: ________________

Bank References:  
Bank Name
Account Officer
Account Number
Loan Number
Bank Phone Number
Bank Fax Number

Please fax all completed U.S. and Canadian forms to: 401.671.6598

Please fax all completed International forms to: 401.671.6599

Summer Infant, Inc.  1275 Park East Drive . Woonsocket, RI 02895 . Phone: 401.671.6550 . Fax: 401.671.6051