S H E R R I ' S    D E S I G N S

7141 Owensmouth Avenue, Canoga Park, California 91303

tel 818.887.4587 – fax 818.887.0299

NEW ACCOUNT INFORMATION

COMPANY NAME: _______________________________________________

SHIPPING ADDRESS: _____________________________________________

BILLING ADDRESS: ______________________________________________

PHONE: _______________________  FAX: __________________________

EMAIL: _______________________   RESALE #: ______________________

PLEASE LIST THREE (3) TRADE REFERENCES:

1. _______________________________________________________

2. _______________________________________________________

3. _______________________________________________________

HOW DID YOU HEAR ABOUT SHERRI’S DESIGNS?:

_______________________________________________________________________________________

I hereby state that the above information is valid and submitted for the purpose of establishing a new account with Sherri’s Designs and agree to the release of trade and bank information for this purpose.

Signature ______________________    Print Name _____________________

Date __________________________  Title  __________________________

NOTE: Once the above information is verified, a price sheet will be sent to you via the method you prefer.

Check one:

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