Billing Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is the billing address the same as the delivery address? *

Yes

No (Please fill out delivery address below.)

Delivery Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Wine Buyer: *

First Name

Last Name

Wine Buyer Phone Number: *

Country

(###)

###

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Name of Owner: *

First Name

Last Name

Onwer Phone Number: *

Country

(###)

###

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Accounts Payable Name: *

First Name

Last Name

Accounts Payable Phone Number: *

Country

(###)

###

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By completing this credit application and checking the box below, buyer agrees to the following: *

Per Floraison Selection's specified payment terms, all invoices must be paid in full within thirty [30] days of the date the product was delivered. Overdue balances are subject to a late payment fee of one and a half percent (1.5%) per month (or any portion thereof) for each and every month the balance remains unpaid. Buyer further agrees to pay any and all fees and costs of whatever nature or description, including, without limitation, fees paid to a collection agency, as well as attorney’s fees, as seller may incur as a result of or in connection with the collection of any invoice, regardless of whether or not suit is instituted or prosecuted to judgment.

Acknowledged