Elegant Moments Lingerie Quality Lingerie

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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:
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
I/my company currently sells:

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