New Wholesale Customer Application

User Info

Account Info

Billing

Shipping

Purchaser Info

Trade References

Bank Reference

User Information

This information will be used to create and access your online account.

Username *

Email *

Password *

Confirm Password *

Please make sure to fill all required fields.

Account Information

Please provide the following information to setup your account.

Account Name *

The name to be associated with this account such as your business' name.

First Name

Last Name

Company Website

URL to your business' website. (must be the full URL)

Principals

Names of other key contacts associated with this account.

Please make sure to fill all required fields.

Billing Information

Information for the company/business associated with billing for this account.

Company Name *

Address *

City *

State *

Zip Code

Billing Contact Person

Contact information for the person associated with billing for this account.

First Name *

Last Name *

Phone *

Email *

Please make sure to fill all required fields.

Shipping Information

Information for the company/business that will receive the orders for this account. (you will be bale to change this information later once your account it approved and activated.)

Company Name *

Address *

City *

State *

Zip Code *

Shipping Contact Person

Contact information for the person associated with receiving for this account.

First Name *

Last Name *

Phone *

Email *

Please make sure to fill all required fields.

Chef/Purchaser Information

Contact Information for the chef or purchaser associated with this account.

First Name *

Last Name *

Phone *

Mobile Phone

Email *

Please make sure to fill all required fields.

Trade References

Reference #1

Company Name *

Address *

City *

State *

Zip Code *

Contact's Name *

Phone *

Email *

Reference #2

Company Name *

Address *

City *

State *

Zip Code *

Contact's Name *

Phone *

Email *

Please make sure to fill all required fields.

Bank Reference

Company Name *

Address *

City *

State *

Zip Code *

Phone *

Account Number *

Account Holder's Name *

Authorization *

I Agree

By checking the box I agree to allow Buon'Italia to contact the trade references listed in this application. I also authorize the release of credit information from the listed financial institution to Buon'Italia.

New Wholesale Customer Application

Reference #1

Reference #2

Need help? Call us at (212) 633-9090

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