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About
Company
International Offices
Careers
Partnership
Looking to Sell
Grow my Brand
Build Your Store
Services
Manufacturers
Services
Marketing
Photography
Logistics
3PL
Packing Services
Technology
Start Here
Resellers
Services
Online Purchases
Product Information
Financial Services
Integration
Start Here
Blog
Contact
Start Your Store
NET Term Form
1
2
3
Credit amount requested
*
Please enter a number from
1
to
10000000
.
Credit Terms
Net 15
Net 30
Net 45
Company Identification
Legal Company Name
*
Trade/DBA Name
Organization Type
*
Corporation-Public
Corporation-Private
LLC
Govt-Agency
Partnership
Sole-Proprietor
Others
State of Business
*
State / Province / Region
Business Established
*
Month
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Day
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1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
United States of America
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Federal Tax ID
*
DUNS Number
Tax Exempt/Resale/Other Certificates
Tax Exempt or Resale/Other?
*
No
Yes
Sales & Use Tax Exemption/Resale - Multijurisdiction?
*
No
Yes
Streamlined Sales & Use Tax Agreement?
*
No
Yes
Business Profile
Style of Business
*
Manufacturer
Distributor
Re-seller
Service
Others
Number of Employees
*
Less than 10 employees
10-20 employees
20-50 employees
50-100 employees
100-250 employees
250-500 employees
500-1,000 employees
1000-3,0000 employees
5,000-10,000 employees
more than 10,000 employees
Annual Sales
*
$0-$200,000
$200,000-$400,000
$400,000-$600,000
$600,000-$800,000
$800,000-$1 million
$1 million-$3 million
$1 million-$3 million
$3 million-$5 million
$5 million-$10 million
$10 million-$25 million
$25 million-$50 million
$50 million-$100 million
$100 million-$300 million
$300 million-$500 million
$500 million-$1 billion
$1 billion-$2 billion
$2 billion-$5 billion
More than $5 billion
Applicant Contact Info
Title
*
CEO
President
Vice President
Chief Financial Officer
Treasurer
Director
Purchasing Manager
Manager
Officer
Owner/Proprietor
Member
Accounts Payable
Controller
Managing Member
Other
Registration Information
*
First Name
Last Name
Work Phone
*
Fax
Email
*
Enter Email
Re-Type E-Mail
Customer P.O. No.:
Web site:
Email Address All invoices and statements are provided electronically to the Email addresses indicated in this box. If hard copies of these documents are required, a member of Basilio Inc's credit team may be contacted.
Primary Contact Email Address:
*
Email Address for Invoices:
Email Address for Statements:
CREDIT CARD INFORMATION
BASILIO INC DOES NOT ACCEPT PAYPAL OR DEBIT CARDS. BY SUBMITTING AND SIGNING THIS SECTION YOU AGREE TO THE TERMS ATTACHED
Customer represents that it is the cardholder, is authorized to use the credit card(s) and authorizes Basilio Inc to process all payments on this credit card(s) regardless of the ship-to address. It is not necessary that the ship-to address and Customer billing address are identical. Any and all charges for product ordered on Customer’s account, regardless of shipping destination, are the responsibility of Customer and will be charged to the credit card(s) authorized herein. Customer understands that by utilizing a debit card for payment, the issuing financial institution may subject Customer’s account to an authorization hold. An authorization hold is a common banking industry practice by which Customer's financial institution places a hold on any available balance equal to Customer's purchase amount while Petra processes payment. The exact dollar amount and the time frame for a release of any authorization hold are set by Customer’s financial institution. Basilio Inc shall not be responsible for any fees or charges incurred as a result of Customer’s use of a debit card, including, but not limited to any fees or charges incurred by Customer as a result of an authorization hold. Customer is responsible for understanding its particular financial institution’s policies regarding authorization holds and the specific effects on Customer’s financials. Customer also agrees to abide by Basilio Inc’s Standard Sales Terms and Conditions (found at www.basilioinc.com / terms) and any other applicable terms and conditions set by Basilio Inc and available upon request by Customer. Customer hereby authorizes Basilio Inc to process payment for all orders made by fax, phone or email to the above-referenced credit card. These orders will be made by the above-listed authorized users. Any changes such as adding or deleting users will be made in writing to Basilio Inc. Customer assumes responsibility for payment
Card Type
*
AMEX
Mastercard/VISA/Discover
Expires
*
Date Format: MM slash DD slash YYYY
Please print name EXACTLY as it appears on card:
*
Authorized users:
*
Billing Address of Card Holder:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Signature
Sales / Order Information E-Comm Customers Are Required to Provide Fulfillment Services Agreemen
Agree to FSA Form for E-Comm Customers Here
Basilio Inc Sales Representative
Basilio Inc Representative
Our Business is a
Retail Storefront
E-Commerce Website
Do you sell products online?
We sell our products online
We DO NOT sell any products online
General description of my business
*
Number of Stores
We will be purchasing products from Basilio Inc for
*
Select All
Resale
Business Use
Attach Credit Documents
Drop files here or
Articles of Incorporation, Misc. Documents, SS-4, Reseller Certificates, Seller License, & Other Pertinent Documents