Full Name of Business Entity:

Business Address:

City, State, Zip:

Phone#:

Fax#:

Retail ID#:

E-Mail Address:

Website URL:

 Owner: (name)

 Partner: (name)

 Manager: (name)

 Buyer: (name)

 Other: (name)

Name of Bank:

Account #

Name On Card:

EXP Date:                            

Billing Address:

City, State, Zip:

1. Name of Business:

Account #

Street Address, City, State, Zip:

Business Phone:

Business Fax:

2. Name of Business:

Account #

Street Address, City, State, Zip:

Business Phone:

Business Fax:

3. Name of Business:

Account #

Street Address, City, State, Zip:

Business Phone:

Business Fax:

The undersigned hereby makes application for wholesale purchasing from Critical Paintball and warrants that all information contained herein is true and correct.  All warranties and liabilities are covered under manufactures policies and not Critical Paintball. The following terms are offered: COD company check/MO O.A.C., or Credit Card. Actual shipping and COD charges apply.

                                     Signed:_______________________________________        Title:____________________________________

                                      Printed Name:_________________________________        Date:____________________________________