Welcome to FINE USA Trading !

Order

New Retail Account Application

Please provide the following information for the wholesale price and further product information.


Date		MM/DD/YY

Business Name
Type of Business		Retail Store
(please check one)		Health Practitioner
		Beautician
		Online

Contact Person
Mailing Address
City
State
Zip
Telephone Number
Fax Number
E-mail
Sellers Permit No / Fed ID

Shipping address		Check if same as Mailing address
Address
City
State
Zip

You may print this application and fax it to the following number if you prefer.
Fax: (310)438-8252

Comments