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Bangalla New Client Form: Check Mark

This document is a new client form for Bangalla Organic Wholesale. It requests information such as business name, owner and contact details, business model, tax IDs, physical address, websites, and how the client heard about Bangalla. The client must agree to Bangalla's terms and conditions by providing a physical signature before being established as a new member.

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Kamber Ali
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We take content rights seriously. If you suspect this is your content, claim it here.
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137 views1 page

Bangalla New Client Form: Check Mark

This document is a new client form for Bangalla Organic Wholesale. It requests information such as business name, owner and contact details, business model, tax IDs, physical address, websites, and how the client heard about Bangalla. The client must agree to Bangalla's terms and conditions by providing a physical signature before being established as a new member.

Uploaded by

Kamber Ali
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Bangalla New Client Form

Place a check mark based on your business model below:


Wholesale_____ FBA _____Dropship_____ Distribution_____ Other______
Please complete the details below to be established as a New Member with Bangalla. Your use of the Bangalla Organic Wholesale
website directly or indirectly of services for Wholesale, Dropship, and Distribution is your acceptance of the Terms & Conditions
found on the Bangalla.com
Legal Business Name______________________________________________________________________________________
(dba(s)_________________________________________________________________________________________________
Owner Name___________________________________ Primary Contact Name_______________________________________
Job Title______________________________________ Time Zone________________________________________________
Primary Email_________________________________ Secondary Email_____________________________________________
Primary Phone_________________________________ Secondary Phone___________________________________________
Mailing Address___________________________________________________________________________________________
City___________________________ State______________ Zip Code___________ Country____________________________
Billing Address___________________________________________________________________________________________
City___________________________ State______________ Zip Code___________ Country____________________________

Please provide at least one of the following documents with the attached copy:
Business ID or Certificate of Formation # / & Attached Copy _______________________________________________________

Tax ID # / EIN # & Attached Copy____________________________________________________________________________

Reseller Certificate # & Attached Copy_______________________________________________________________________

Bangalla is committed to help our manufacturers detect fraudulent products and prove a valid supply chain. Please provide the
following information to help Bangalla keep a record of where our products are being sold.

Physical Location (Brick and Mortar Store) ____________________________________________________________________

Business Website(s)_______________________________________________________________________________________

Third party platform(s), usernames___________________________________________________________________________


________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
If you add a location, you will need to inform Bangalla via email to keep a written record and track of a valid supply chain.

(REQUIRED)For Marketing Purposes: How did you find us or who referred you to us: ____________________________________

BY SIGNING BELOW, I CERTIFY THAT I AM AUTHORIZED TO SUBMIT THIS APPLICATION ON BEHALF OF THE COMPANY NAMED
ABOVE, ALSO REFERRED TO AS “APPLICANT,” “FIRM,” OR “BUYER,” AND THAT ALL INFORMATION AND DOCUMENTS PROVIDED
IN CONNECTION WITH THIS CURRENT APPLICATION ARE TRUE, CORRECT AND COMPLETE. FURTHER, I HEREBY AGREE TO PAY
REASONABLE COLLECTION COSTS, ATTORNEY’S FEES AND COURT COSTS IF BANGALLA ORGANIC WHOLESALE LLC, DBA BANGALLA
ORGANIC WHOLESALE TAKES STEPS TO COLLECT ON OVERDUE AMOUNTS. IN ADDITION, I AM AGREEING TO ALL OF BANGALLA
ORGANIC WHOLESALE LLC, DBA BANGALLA ORGANIC WHOLESALE TERMS AND CONDITIONS LOCATED ON THE ORGANIC
WHOLESALE CLUB WEBSITE WWW.BANGALLA.COM/TERMS-CONDITIONS

Your Physical, Handwritten Signature __________________________________________Date________________________

Note: All details are kept in strict confidence. Once complete, please return signed agreement via email to
info@bangalla.com

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