The Walmart Community Card is for governmental agencies and non-profit
organizations only, such as: charity, hospitals, schools or
religious organizations. If you are a for-profit business please
apply for our Business Credit Account.
This form is designed to be filled out by you online and then
printed. To shorten response time, please carefully and completely
answer all questions and then sign and date the application.
Once complete, you may submit by fax, or mail. Print an extra copy for your records.
Please read the following before completing this
form. (1) Applicant represents that the information
given in this Application is complete and accurate.
(2) If applying for credit you authorize us to check
with credit reporting agencies, credit references
and other sources disclosed herein in investigating
the information given. (3) Signatory must be an
authorized representative of the company with authority
to enter into contractual agreements.
PO Box 628406
Orlando, FL 32862-8406
Your Organization or Company Information
full legal name (Limited to 26 characters)
organization or company is doing business as
(Your account will be set up in this name. Limited
to 26 characters)
Street Address (Street
Name and Number Required)
Tax Exempt 501 (c) (3)
Number of authorized
buyer cards you need
(up to 95)
organization or business
(Check only one)
Billing Contact(Your billing statement
will be mailed in attention of the billing contact
name listed below. Limited to 26 characters)
Billing Address(if different from above)
Name (if it applies.
Limited to 26 characters)
Address(Street Name and Number required)
Purchase Orders Required?
Your business has the ability to purchase using purchase order(s) numbers. Walmart Stores, Inc will not be responsible for returning copies of the purchase order to your business. You will receive itemized billing statements with your purchase order number included.
2. Your Signature
You must be one of these: (Check
President or Chairman
Owner or Sole Proprietor
NOTICE TO BUYER:
(1) DO NOT SIGN THIS APPLICATION
BEFORE YOU READ IT.
(2) YOU ARE ENTITLED TO
A COMPLETELY FILLED IN COPY OF THE GOVERNING CREDIT
(3) YOU MAY AT ANY TIME
PAY THE TOTAL BALANCE UNDER THE AGREEMENT
By signing below, on behalf of your business, you
represent that your business is a valid nonprofit
business entity; that all purchases made on the
Account, if approved, will be for purposes other
than personal, family or household use; and you
are an authorized representative of the business
with authority to enter into contractual agreements.
On behalf of the business, you certify that all
information provided in this Application is complete
and accurate, and you agree that the terms of the
Walmart Community Charge Card Account, which you will receive
upon Account approval, will govern your Account.
By signing below you authorize Synchrony Bank to obtain information about your business
(or you if your business is a proprietorship or partnership)
from credit reporting agencies and other sources Synchrony Bank deems appropriate in connection with your
Application and subsequently for purposes of updates,
renewals or extensions of credit granted as a result
of this Application, or in receiving or collecting the
Account. You also understand there
is no binding contract until your Application is
You consent to Synchrony Bank
and any other owner or servicer of the Account contacting
you about the Account, including using any contact information
or cell phone numbers you provide, and you consent to the
use of any automatic telephone dialing system and/or an artificial
or prerecorded voice when contacting you, even if you are
charged for the call under your phone plan.
Federal law requires us to obtain, verify and record
information that identifies your business when you
open an Account on its behalf. We will use the name,
address, taxpayer ID# and other information of your
business for this purpose.
Signature of Company's
*For Foreign Persons: Passport Number, Date(s) of Issuance and Expiration, and Country of Issuance, or other similar identification number. In lieu of a passport number, foreign persons may also provide an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard.
Street Address (Street
Name and Number Required)
Date of Birth
balance due in full each month.
Late Payment Fees:
6.92% to 18% of unpaid balance (varies by state).
The information about
costs of the card is accurate as of 02/01/2017. To
find out what information may have changed, write
to Walmart Community Credit Services, P.O. Box
965022, Orlando, FL 32896-5022. The terms of this Agreement
may be changed provided by the Agreement.
double check and then print this form
To shorten response time, please carefully and
completely answer all questions and then sign
and date the application. Once complete, you may
submit by fax or mail.