CreditApplication Box Partners

Welcome to BOX!
We would like to welcome you as a BOX Partners customer!
Please take a few minutes to give us your account information. This information ensures
accuracy setting up your account and gives us the necessary information to provide you
with the best service in the industry.
To be sold on open account, kindly complete and sign the attached Application for
Credit and Bank Authorization.
If your purchases are not subject to tax, please complete and sign the attached
Illinois CRT-61 Certificate of Resale or the Uniform Sales & Use Tax Exemption/Resale
Certificate. Without one of these signed certificates in our files, we are required by law
to charge sales tax.
Kindly complete and return as soon as possible to avoid delays in processing

your orders. Our fax number is (847) 783-9145.
Thanks again for choosing BOX! We look forward to servicing you!
BOX Partners, LLC • 2650 Galvin Drive • Elgin, Illinois 60124

Phone: (800) 742-6937 • Fax: (800) 621-9084 • Web: boxpartners.com
NEW ACCOUNT INFORMATION - PAGE 1
Account Setup
I/we hereby apply for extension of credit. The following information is submitted in confidence.
Company Name:
Dema Store LLC

Billing Address:
4747 N Nob Hill Rd Suite 6

City: State: Postal Code:
Sunrise FL 33351
Phone: Fax/E-Mail:
4246039193
Billing Contact: E-Mail:
Maykel Barlavento [email protected]

Preferred Invoice Method: Invoice E-Mail Address/Fax #:
x E-Mail Fax [email protected]
Ship To
Only if different from above and will apply to every order.
Address:
City: State: Postal Code:
Shipping Special Instructions

We assume you are open for receiving 8:00 AM to 5:00 PM Monday through Friday. Kindly
provide us with any information that may make our delivery to you as smooth as possible.
Receiving hours 8am to 2pm
CREDIT APPLICATION
Rev 6.0
www.boxpartners.com
NEW ACCOUNT INFORMATION - PAGE 2
Application for Credit

Legal Name of Company: Year Established:
Dema Store LLC 2018

Subsidiary/Division of: City: State: Postal Code:
Sunrise FL 33351
Type of Business: Corporation Partnership Proprietorship LLC
Federal Identification Number: Initial Credit Requested:
82-5101153
Principal/Owner/Officer 1: Phone:
Maykel Barlavento 4246039193

Principal/Owner/Officer 2: Phone:
Trade References
Please list only accounts with which you have CURRENT open credit terms (no COD).
Major Trade Supplier 1: Acct #: Phone: Fax/E-Mail:
Stephanie Camputaro 8774962746 [email protected]
Grace Zhang 6045236866 [email protected]
Philippe Charest-Beaudry 1 800 595-9143 [email protected]
Our Terms are Net 30

I HEREBY CERTIFY: That all the information on this form is correct. I/we fully understand your credit terms and agree to the proper
payment in consideration of extended credit. I/we agree to pay 1 1/2% per month, 18% yearly, on all past due balances. If our company
defaults on payment of any outstanding valid invoices, I/we agree to pay for BOX Partners’ attorney fees, collection expenses and all court
costs arising from our failure to pay. MUST BE SIGNED BY AN OFFICER OR PRINCIPAL OF THE COMPANY IN ORDER TO BE PROCESSED.
Digitally signed by Maykel
Barlavento
Date: 2023.11.28 15:09:11
-05'00'
Maykel Barlavento Owner 11/28/23
Signature Printed Name Title Date
CREDIT APPLICATION
Rev 6.0
www.boxpartners.com
BANK REFERENCES - PAGE 3
Bank Authorization
Bank Name: Phone: Fax/E-Mail:
Wells Fargo (954) 467-4145

Bank Address: City: State: Postal Code:
278 Indian Trace Weston FL 33326
To Bank Personnel
Checking Account #: Company Name:
2437667237 Dema Store LLC

For the purpose of establishing an open account with BOX Partners, LLC, I/we hereby authorize you to release information on our
commercial accounts.
Digitally signed by Maykel

Barlavento
Date: 2023.11.28 15:11:57 -05'00' Maykel Barlavento Owner 11/28/23
Signature Printed Name Title Date
The Following to be Completed by Bank

So we may consider granting open account terms to the customer, we ask you, in confidence, to supply us with the following information.
Checking Open Date: Avg. Balance: NSF/Return Checks? Rating on account:
Y N
Loan Open Date: High Credit: Secured? Collateral:
Y N
Current Status? Past Due Amount: Balance Owing: Rating:
Y N
Return Fax: (847) 783-9145
BOX Partners, LLC

2650 Galvin Drive
Elgin, IL 60124
(847) 783-9000
www.boxpartners.com
CREDIT APPLICATION
Rev 6.0
www.boxpartners.com
SALES TAX - PAGE 4
If the products you are purchasing from us are tax exempt, please complete and return
a copy of the Illinois CRT-61 Certificate of Resale or the Uniform Sales & Use Tax Exemption/
Resale Certificate immediately via fax (blank copies follow). Without one
of these signed certificates in our files, we are required by law to charge sales tax.
Return Fax: (847) 783-9145
BOX Partners, LLC

2650 Galvin Drive
Elgin, IL 60124
(847) 783-9000
www.boxpartners.com
CREDIT APPLICATION
Rev 6.0
www.boxpartners.com

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Welcome to BOX!

We would like to welcome you as a BOX Partners customer!

Kindly complete and return as soon as possible to avoid delays in processing

Thanks again for choosing BOX! We look forward to servicing you!

BOX Partners, LLC • 2650 Galvin Drive • Elgin, Illinois 60124

Dema Store LLC

4747 N Nob Hill Rd Suite 6

Maykel Barlavento [email protected]

x E-Mail Fax [email protected]

City: State: Postal Code:

Shipping Special Instructions

Receiving hours 8am to 2pm

Application for Credit

Dema Store LLC 2018

Federal Identification Number: Initial Credit Requested:

Maykel Barlavento 4246039193

Major Trade Supplier 1: Acct #: Phone: Fax/E-Mail:

Stephanie Camputaro 8774962746 [email protected]

Major Trade Supplier 2: Acct #: Phone: Fax/E-Mail:

Grace Zhang 6045236866 [email protected]

Major Trade Supplier 3: Acct #: Phone: Fax/E-Mail:

Philippe Charest-Beaudry 1 800 595-9143 [email protected]

Our Terms are Net 30

Wells Fargo (954) 467-4145

278 Indian Trace Weston FL 33326

2437667237 Dema Store LLC

Digitally signed by Maykel

The Following to be Completed by Bank

Checking Open Date: Avg. Balance: NSF/Return Checks? Rating on account:

Loan Open Date: High Credit: Secured? Collateral:

Current Status? Past Due Amount: Balance Owing: Rating:

Return Fax: (847) 783-9145

BOX Partners, LLC

Return Fax: (847) 783-9145

BOX Partners, LLC

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