2024 R.R. LALENA BUYER'S GUIDE

NEW ACCOUNT FORM DATE: ____/_____/_____ TAX ID #: ________________________________________________________ BUSINESS NAME: ________________________________________________________________________ OWNER’S NAME: ________________________________________________________________________ ADDRESS: ______________________________________________________________________________ CITY: ________________________________ STATE: _____________________ ZIP CODE: _____________ COUNTRY: _____________________ TEL #: ______________________ FAX #: ______________________ E-MAIL: ________________________________ WEBSITE: _______________________________________ TYPE OF BUSINESS:  CAR WASH  GAS STATION  WHOLESALE / RETAIL  CONV. STORE  OTHER ______________________________________ NAME OF THE PERSON RESPONSIBLE FOR PURCHASING: ____________________________________ HOW DID YOU HEAR ABOUT OUR COMPANY:  INTERNET  MAGAZINE  REFERRED BY SOMEONE  LALENA’S ADVERTISEMENT  OTHER ____________________ HOW LONG HAVE YOU BEEN IN THIS BUSINESS: _____________________________________________ FORM OF PAYMENT: ( NOTE : FIRST ORDER MUST BE PAID CASH, MONEY ORDER OR CREDIT CARD ONLY.) 1.  CASH 2.  CREDIT CARD  VISA  MASTER CARD  AMERICAN EXPRESS  DISCOVER NOTE : IF PAYING BY CREDIT CARD, IT WILL BE APPLIED CONVENIENCE FEE (3% OF TOTAL AMOUNT) 3.  CHECK IF PAYING BY CHECK, PLEASE PROVIDE US BANK INFORMATION. NOTE : IF YOUR CHECK BOUNCES, THERE WILL BE AN ADDITIONAL $40 FEE ON TOP OF THE TOTAL ORDER AMOUNT. BANK NAME: ___________________________________________________________________________ BRANCH MANAGER NAME: _______________________________________________________________ ADDRESS: ______________________________________________________________________________ CITY: ________________________________ STATE: _____________________ ZIP CODE: _____________ BANK TEL #: ______________________ BANK FAX #: ______________________ CHECKING ACCOUNT #: __________________________________________________________________ I, ____________________________________________________________________ hereby authorize R.R. LALENA CORPORATION to receive credit information of the above checking account. SIGNATURE: ________________________________________________ CREDIT TERMS : PLEASE REQUEST “APPLICATION FORM FOR TERMS”. YOU NEED TO FILL OUT ALL FORM PAGES FOR APPROVAL. R.R. LALENA CORPORATION 59-26 55th DRIVE, MASPETH, NY 11378 USA TEL: 718.326.9788 | FAX: 718.326.8765 | TOLL FREE: 1.800.R.LALENA | WEBSITE: RRLALENA.com