Wholesale account

New Client Application

Open a verified buyer account with Starlight Distributors. Submit the online form below. For questions, email Info@starlight-distributors.com.

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1. Name & Address

Last name *

First name *

M.I.

Title

Company name *

Tax ID / EIN *

Address *

City *

State *

ZIP *

Phone *

Email *

2. Business Information

Type of business

In operation since

Legal form

Parent company (if subsidiary)

Parent in operation since

3a. Principal Officer

Name *

Title

Address

City

State

ZIP

Phone

3b. Second Principal (optional)

Name

Title

Address

City

State

ZIP

Phone

4. Bank References

Provide up to three. At least one strongly recommended.

Bank #1

Institution

Account #

Address

Phone

Bank #2

Institution

Account #

Address

Phone

Bank #3

Institution

Account #

Address

Phone

5. Trade References

Provide up to three suppliers extending you credit.

Trade #1

Company

Contact

Address

Phone

Since

Limit

Balance

Trade #2

Company

Contact

Address

Phone

Since

Limit

Balance

Trade #3

Company

Contact

Address

Phone

Since

Limit

Balance

6. Certification & Signature

I hereby certify that the information in this application is complete and accurate. This information is provided with the understanding that it will be used to determine approval of a new account. I further authorize the financial institutions listed above to release necessary information to Starlight Distributors LLC and/or its affiliates to verify the information contained herein. I have read and agree to the Terms of Sale and Wholesale Buyer Agreement.

Type full name as electronic signature *