Walmart Community Account Application

 
 
The Community Account is for governmental agencies and non-profit organizations only, such as: charily, 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.
 
     
 
Fax
  1-866-511-4015
APPLICANT: 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.
     
Mail
  Wal-Mart Community
PO Box 628406
Orlando, FL 32862-8406
   
     
 
     
 
1. Your Organization or Company Information
 
Your organization or company's
full legal name

(Limited to 26 characters)
Name your 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)
 
City
State
Zip
Phone
( ) - Ext:
Fax
( ) -
Tax Exempt 501 (c) (3) Number (required)
Number of authorized buyer cards you need (up to 99)
 
Type of organization or business (Check only one)
Nonprofit Religious Governmental Agency Other ____________________
 
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)
 
City
State
Zip
Phone
( ) - Ext:
Fax
( ) -
 
Parent Company Name (if it applies. Limited to 26 characters)
Street Address (Street Name and Number required)
 
City
State
Zip
Phone
( ) - Ext:
 
 
Purchase Orders Required?
Yes No
Your business has the ability to purchase using purchase order(s) numbers. Wal-Mart 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.
Dun & Bradstreet #  
 
  2. Your Signature

You must be one of these: (Check one.)
President or Chairman General Partner Vice President Other Officer 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 AGREEMENT.
    (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 Wal-Mart Community and & Business Commercial Charge Account Agreement, which you will receive upon Account approval, will govern your Account. By signing below you authorize General Electric Capital Corporation ("GE Capital") to obtain information about your business (or you if your business is a proprietorship or partnership) from credit reporting agencies and other sources GE Capital 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 approved.

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.
X
Signature of Company's authorized representative
   
Authorized Representative Name
Social Security #
- -
Authorized Representative Title
Application date:
 
Payment Terms: 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 10/01/2010. To find out what information may have changed, write to Wal-Mart Community Credit Services, P.O. Box 981257, El Paso, TX 79998. The terms of this Agreement may be changed provided by the Agreement.
 
Please 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