Credit application Kouture Ventures – Credit Application Credit Application 1 Business Profile Business identity Legal Business Name * Trading / DBA Name (if different) Entity Structure * — Select — Corporation Limited Company (Ltd) Public Limited Company (PLC) Limited Liability Company (LLC) Limited Liability Partnership (LLP) General Partnership Sole Proprietorship / Trader Non-Profit / Charity Other Business Type * — Select — Optical Retail Optical Boutique Optometry Practice Ophthalmology Clinic Online / E-Commerce Wholesale / Distributor Years in Business * Tax ID / FEIN / VAT Number * Ownership Status Own Building Lease Premises Home-Based Business address Street Address * City * State / Province * ZIP / Postal Code * Country * Business contact Business Phone * Mobile / Cell * Business Email * Website Fax (optional) 2 Owner / Principal(s) List all principals with 20% or greater ownership. Add additional owners as needed. Owner 1 – Primary First Name * Last Name * Title / Role Ownership % Mobile * Email * Home Address (Street, City, State, ZIP, Country) Owner 2 – if applicable First Name Last Name Title / Role Ownership % Mobile Email Home Address (Street, City, State, ZIP, Country) 3 Prior Account History Have you or your business previously held an account with Kouture Ventures or any of our affiliated brands? No — this is a new account Yes — we have had a prior account Account / Business Name on File Account Number (if known) Approximate Year of Last Order Reason Account was Closed / Inactive 4 Purchasing & Preferences Ordering Preference Stock Orders Board Management Inventory Review Frequency Quarterly Semester (6 months) Annual Estimated Monthly Purchase Volume (USD) Under $500 $500 – $1,999 $2,000 – $4,999 $5,000 – $9,999 $10,000+ Requested Credit Limit (USD) 5 Trade References Provide 3 independent frame suppliers for credit worthiness (e.g., Europa, OGI, WestGroupe). Do not list your top 5 primary suppliers. Reference 1 Company Name * Account Number Contact Person * Email * Phone Years as Customer Reference 2 Company Name * Account Number Contact Person * Email * Phone Years as Customer Reference 3 Company Name * Account Number Contact Person * Email * Phone Years as Customer 6 Tax Compliance Upload your State Sales Tax Exemption Certificate. Download the applicable form for your state: Florida DR-13 California CDTFA-230 Texas 01-339 New York ST-120 ⇧ Click to upload tax certificate (PDF, JPG, PNG) Submit Application
