Elegant Moments Lingerie Quality Lingerie

     Popular Links: Home | New Account Form | Credit Card Authorization Form | Catalog Order | Contact Us Bookmark and Share
Note: We have recently updated our application notification systems. If you experience any technical issues with this form please submit a new application directly via email to elegantmoments2@aol.com or via fax 570-489-5619 using this form.

New Account Application - Please fill in all fields.

Elegant Moments is a lingerie manufacturer. We must remind you that Elegant Moments Lingerie is for the retail trade ONLY. You must have a legitimate business license and a Federal Tax ID number (for US customers). International customers will be processed on a case-by-case basis. Please fill out the form below and fax your Business Certificate or Tax ID to 570-489-5619.


First Name:   Last Name:
Business Name:
Address:
Suite/Apt No::
City: State:
Zipcode:      Country:
Tax ID#:
 
Email Address:      Website URL:
Phone:      Fax:
 
Three Trade References*
Reference 1: Phone:
Reference 2: Phone:
Reference 3: Phone:
*If you do not have any trade references your first two orders must be prepaid with a money order, cashiers check or certified check.
 
Bank References
Bank Name: Account Number:
Phone: Contact:
 
Bank Name: Account Number:
Phone: Contact:
 
Bank Name: Account Number:
Phone: Contact:
 
*Are you an existing customer: required
*What is your business type: required
*How long have you been in business: required
*How did you hear about us: required
*Would you be interested in our DROP SHIP service: required
*Expected business (volume) projections: required
 
Please select your catalogs*:
*Sent upon complete verification of new account application and account activation.
 
Lingerie Collection/Leather Collection/Vinyl Collection
Vivace Collection
Costume Collection
Hosiery Collection
 
Comments
 
Optional
I/my company currently sells:
 
 

Please type this code into the box below and click the submit button:
CAPTCHA Image  Reload Image






Copyright (c) 2003-2010 Elegant Moments. All rights reserved.