This is a wholesale inquiry form. Please provide the following details: If you prefer, you can download our PDF form, fill in the information, and email it to us at [email protected]. Please note that downloading and filling out the PDF form will fulfill the submission requirements, and there is no need to submit the form below if you choose this option. Download PDF Form Your Name Your Email Your Phone Number Company Name Business Address EIN (Tax ID) Number Response Full Name (First Last) SSN or ITIN Bank Name Account No. Account Routing No. Upload Document Card Holder Name Card Number Card Expiration (MM/YY) CCV Zip Code PayPal Email Payable Name BY CHECKING THIS BOX, I, ON BEHALF OF THE BUSINESS AND AS A GUARANTOR, CONFIRM THAT I HAVE READ AND AGREE TO THE PRIVACY POLICY, RETURN AND REFUND POLICY, ELECTRONIC COMMUNICATIONS, CREDIT PROFILE AUTHORIZATION, AND MOBILE TERMS OF SERVICE. I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT, I AGREE TO USE THE FINANCIAL INFORMATION FOR ALL OF MY PAYMENTS WITH BLACK STONE FURNITURE LLC, AND I UNDERSTAND THAT THEY HAVE ALL RIGHTS TO USE MY INFORMATION. I WISH TO RECEIVE PROMOTIONAL SMS TEXT MESSAGES SENT TO MY MOBILE PHONE ABOVE USING AUTOMATED TECHNOLOGY. I UNDERSTAND THAT MY CONSENT IS NOT REQUIRED AS A CONDITION OF APPLICATION, AND THAT MESSAGE AND DATA RATES MAY APPLY. PLEASE REVIEW TERMS HERE. TEXT STOP TO OPT OUT OR HELP FOR HELP. BY CLICKING CONTINUE BELOW, I REPRESENT AND WARRANT THAT I AM AUTHORIZED TO SUBMIT THIS APPLICATION ON BEHALF OF THE BUSINESS AND TO BIND THE BUSINESS ENTITY SHOULD THE APPLICATION BE APPROVED. TO HELP THE GOVERNMENT FIGHT THE FUNDING OF TERRORISM AND MONEY LAUNDERING ACTIVITIES, FEDERAL LAW REQUIRES ALL FINANCIAL INSTITUTIONS TO OBTAIN, VERIFY, AND RECORD INFORMATION THAT IDENTIFIES EACH PERSON WHO OPENS AN ACCOUNT.
