Safe Beginnings Inc.
13 Alexander Rd # 5
Billerica MA 01821
Phone 1-800-598-8911
Fax 1-800-236-9890

Account Application

Company Information
Company Name		Telephone
D/B/A		Fax
Billing Address	City State Zip
Shipping Address (if different from Billing Address)	City State Zip
Resale #		(Please fax copy of resale Certificate)
Years in Business
Type of Business: Corporation , Partnership , Sole Proprietor , Limited Liability Co
Web Site		Do you sell on the Web?	Yes No
Principals/Officers
First Name Last Name		First Name Last Name
Social Security #		Social Security #
Home Address		Home Address
City,State Zip		City/State/Zip
Home Phone		Home Phone
Email		Email
Trade References
Vendor Name		Vendor Name
Account #		Account #
City/State		City/State
Telephone #		Telephone #
Bank Information
Bank Name		Bank Name
Bank Phone		Bank Phone
City,State Zip		Acct #
Credit Card	Mastercard Visa Discover (Sorry, we do not accept American Express)
Credit Card #		Exp Date: / mm/yyyy example: 02/2003

Desired Online Password (optional):

Check here if you have not registered with our web site yet and want to receive an account to view our online catalog. (You will receive an account username and password via your email given above).

If you have already registered online, your account information will be updated.

I hereby authorize Safe Beginnings, Inc. to receive the requested credit and bank information listed for the purpose of obtaining an open line of credit. I understand if terms are granted that they are net 30 days from date of invoice and that overdue invoices may be charged to the credit card listed above.

Please digitally sign this application by entering the city and state of your birth:

Policies, Terms & Conditions