Hilton Lifestyle Group
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Authorized Retailer Application

 

Authorized Distributor Credit Application

Please fill out the form completely to avoid delays in processing. 

 

Please complete the form below

Address *
Address
Selling Channels *
Phone *
Phone
http://
Company Information
Entity Type *
In Business Since *
In Business Since
Is this business a Division/Subsidiary? *
Name of Officer or Principal *
Name of Officer or Principal
Phone
Phone
Bank Reference
Institution Address *
Institution Address
Phone 1
Phone 1
Fax
Fax
Trade References
Address *
Address
Address *
Address
Authorization
I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. We further acknowledge that credit, if granted, may be withdrawn at any time. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied.
Date *
Date