PRINT Wholesaler Application Form

Please print and sign the following documents and fax it to us at (714) 540-5668 along with your business license and driver license.

By signing this agreement and the wholesale buyer’s company certifies that the company is in the business of reselling merchandise and have provided proper business and resale license information to Sergios Collection. The wholesale buyer’s company acknowledges and agrees to the terms and policy set forth in Sergios Collection wholesale agreement. The wholesale policy is available for review at

http://www.sergioscollection.com

Wholesale Buyer’s Company 

Company name:__________________________________________________________________

Signed by: _____________________________ 

Title:________________________________ 

Phone number: ______________________________

E-Mail: ____________________________________

Authorized Signature 

Print Name:_____________________________ Date: ______________________


Sergios Collection
3410 W. MacArthur Blvd. # F - Santa Ana, CA - 92704 - U.S.A
Tel: (714) 540 5222 - Fax: (714) 540-5668

CREDIT CARDHOLDER AUTHORIZATION FORM
(For payment on wholesale orders via credit card or COD. We will charge this authorization for COD only if the payment is not received.)


Date: _______________

I, ______________________________________________ 
authorize Sergios Collection, (Name of cardholder as it appears on the credit card)

to charge _______________/_______________________________ /________________

(credit card name) (credit card number) 
(expiration date)

for wholesale purchases placed with Sergios Collection. 

Note:

1.. Please provide the address that matches with the credit card monthly statement below. 
2.. Please provide the three or four digits CVV code listed on the back of your credit card. 
3.. Sign and fax this form along with a copy of your driver license to (714) 540-5668. 

800 Customer service # _________________________

Billing Address: ___________________________________________________

City ________________ State: ________ Zip: _____________


CVV code _____ (3 digits for Visa or Master Card in the back of the card, 4 digits for 
American Express in the front of the card)

By signing below, I authorize Sergios Collection to charge my credit card for the payment of my wholesale purchases. This authorization will remain in effect until the business relationship is terminated with a formal written request. 

__________________________

Signature of Cardholder___________________________

Printed Name_______________________

Date _______________________

PRINT Wholesaler Application Form