Retailer Register

To register as a RNC dealer fill out the form below

There is a separate application for eCommerce, please call our office for details:

401-435-6777 TOLL—FREE 1-800-435-7892


This is not a credit application. If you want to apply for credit download the application.


1. Company Information
Company NAME
Type of Company If Other:
D/B/A'S (if applicable)
Website url Email Address
2. Billing Information
contact First NAME Contact Last Name
Street/p.o. box City
State Zip
Phone () - ext.
Fax () -
3. Shipping Information
Same as billing information
Contact First Name Contact Last Name
Street/p.o. box City
State Zip
Phone ( ) - ext.
Fax ( ) -
4. Type of organization
Select Corporation Branch Partnership Individual
Federal I.D. ## - Sales tax #
BUYERS (authorized to place orders)
Check Signer
A/P Contact
Bank Name Account Number
Bank Phone () - ext.
Bank Fax () -
If additional bank account numbers or fax numbers apply, please email us at
5. Terms of Payment
PREPAY by Check, (I wish to apply for check writing privileges), WIRE TRANSFER or CASH. (Prepay orders are considered quotes, and only held for twenty days. If payment is not received within twenty days, quote is void. The date payment is received will be considered the order date and normal lead times will apply from this date.)
CREDITS - I wish to apply for credit, (net 30 terms).
I wish to apply for an estimated monthly credit line of
CREDIT CARD - I wish to pay with a VISA or MASTERCARD
  If you would like to pay regularly by credit card, please provide the following information:
Name of Cardholder
Credit Card Number - - -
Vcode Expiration date /
Credit Card Company MASTERCARD VISA
Billing Address City
State Zip
I would like my credit card information kept on file at RNC: Yes No
I Hearby Authorize Rustic Warehouse, Inc. to Charge Order to my Credit Card.


We Do Not Offer COD

If you would like to apply for credit, please call and request our credit application.


I hereby authorize the release of credit information on my company/myself to Rustic Warehouse, Inc., for the consideration of receiving net 30 payment terms with Rustic Warehouse, Inc. Purchaser hereby agrees to Rustic Warehouse, Inc.’s invoice policy and terms of sale and agrees to prompt payment for all balances when due to Rustic Warehouse, Inc. A late fee will be assessed against all over due invoices at the rate of 1 1/2% per month. A fee in the amount of $25.00 will be assessed on all returned checks. The customer agrees to pay all collection costs, or costs of attempting to collect delinquent payments, including attorney fees.
I agree to Rustic Natural Cedar's website Privacy Policy and authorize Rustic Natural Cedar to save my personal information.
Enter your full name
How did you hear about us? Trade Show: